Inflammation-based scores do not predict post-transplant recurrence of hepatocellular carcinoma in patients within milan criteria

Abstract

Increased preoperative inflammation scores, such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and inflammation-based index (IBI) have been related to post-transplant HCC recurrence. We evaluated the association between inflammation-based scores (NLR, PLR, IBI) and post-LT HCC recurrence as well as tumor necrosis after transarterial embolization. 150 consecutive patients who underwent transplantation for HCC within the Milan criteria between 1996 and 2010 were included; data regarding inflammatory markers, patient and tumor characteristics were analyzed. NLR, PLR, and IBI were not significantly associated with post-LT HCC recurrence or worse overall survival. Increased NLR and PLR were associated with complete tumor necrosis in the subset of patients who received preoperative transarterial embolization (P < 0.05). Cox regression analysis revealed that absence of neoadjuvant transarterial therapy (OR 5 4.33, 95% CI 5 1.28-14.64; P 5 0.02) and no fulfillment of the Milan criteria in the explanted liver (OR 5 3.34, 95% CI 5 1.08-10.35; P 5 0.04) were independently associated with post-LT HCC recurrence inflammation-based scores did not predict HCC recurrence post-LT in our group of patients. NLR and PLR were associated with better response to TAE, as this was recorded histologically in the explanted liver. Histological fulfillment of the Milan criteria and absence of neoadjuvant transarterial treatment were significantly associated with post-LT HCC recurrence.

Risk of posttransplant hepatocellular carcinoma recurrence is greater in recipients with higher platelet counts in living donor liver transplantation

“…No inflammation-based scores, including PLR, were superior to preoperative PLT, in agreement with a previous study. (20) In particular, the significance of PLR despite the insignificance of neutrophil, lymphocyte, and NLR supports the dominant importance of platelets per se. In contrast to the surrogate markers, platelets are effector cells that directly interact with cancer cells in the metastatic cascade (4)(5)(6)(7)10,11) ; thus, their association with tumor recurrence appears to be robust and independent in liver transplant recipients whose systemic inflammation status and PLTs are both affected by liver disease.…”

“…(20) Definition and cutoff value of the inflammation-based scores were determined in previous research. (20) After matching, all analyses were performed by accounting for clustering within the matched pairs and weighting by nonfixed matching ratio. Baseline characteristics were analyzed using clustered linear modeling (continuous variables) or the Cochran-Mantel-Haenszel test (categorical variables).…”

“…Preoperative PLT was negatively associated with the amount of transfused platelets during surgery (coefficient -0.49; P < 0.001), during the first week after surgery (coefficient -0.55; P < 0.001), and between 1 and 2 weeks after surgery (coefficient -0.21; P < 0.001). Accordingly, the amount of transfused platelets during surgery, during the first week after surgery, and between 1 and 2 weeks after surgery was 0 (0-6), 9 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22), and 0 (0-0) units in the low platelet group and 0 (0-0), 0 (0-4), and 0 (0-0) units in the high platelet group, respectively, where 1 unit of apheresis platelets was considered to be equivalent to 6 units of platelets, as described previously. (22) Minimum PLT measured at each postoperative day during the first 2 weeks after transplantation was consistently <30 3 10 9 /L in median within the subgroup of recipients who underwent platelet transfusion on each corresponding day, indicating that platelet transfusion was performed according to our standardized protocol targeting PLT >30 3 10 9 /L (Supporting Fig.…”

Strategies to improve outcome of patients with hepatocellular carcinoma receiving a liver transplantation

“…The combination of PIVKA-Ⅱ and AFP provided increased accuracy than any of them alone [53] . Other biomarkers related to systemic inflammation such as neutrophilto-lymphocyte ratio, platelet-to-lymphocyte ratio and inflammation-based index have been associated with poor survival in HCC [54,55] , but their role in predicting HCC recurrence after LT is controversial [29,56,57] , probably because these parameters are highly influenced by after the liver biopsy [31] casts doubts on recommending this procedure to all patients with HCC before LT. Unfortunately the Toronto criteria have not been validated in independent cohorts.…”

The platelet-to-lymphocyte ratio predicts poor survival in patients with huge hepatocellular carcinoma that received transarterial chemoembolization

“…In contrast, Parisi et al reported the negative predictive role of PLR and NLR in HCC patients receiving liver transplantation [31], which appears that inflammatory markers do not have a predictive role in smaller tumor. One of reasons was the careful selection of transplantation candidates and strict adherence to the Milan criteria in this report.…”