Lymphocyte to monocyte ratio and neutrophil to lymphocyte ratio are superior inflammation‐based predictors of recurrence in patients with hepatocellular carcinoma after hepatic resection

Yang, Tian-Bo; Zhu, Jinmin; Zhao, Lei; Mai, Kangye; Ye, Jiazhou; Huang, Shan; Zhao, Yi‐Fang

doi:10.1002/jso.24549

Cited by 56 publications

(63 citation statements)

References 43 publications

(51 reference statements)

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“…Subsequently, 3 articles did not meet the inclusion criteria and were therefore excluded. Eventually, seven studies, comprising a total of 2,507 patients, were considered eligible for the present meta-analysis18242526272829. The PRISMA flow diagram of the study selection process was shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

The pretreatment lymphocyte to monocyte ratio predicts clinical outcome for patients with hepatocellular carcinoma: A meta-analysis

Song

Tian

Wang

et al. 2017

Sci Rep

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The lymphocyte-to-monocyte ratio (LMR) has been reported to predict clinical outcomes in multiple malignancies. The aim of this study was to assess the prognostic role of pretreatment LMR in hepatocellular carcinoma (HCC). A total of seven studies comprising 2,738 patients were included in the meta-analysis. Pooled results showed that elevated LMR was significantly associated with increased overall survival (OS) (HR: 0.31, 95% CI: 0.20–0.47, p < 0.001), disease-free survival (DFS)/recurrence-free survival (RFS) (HR: 0.57, 95% CI: 0.49–0.67, p < 0.001). The favorable prognostic impact of high LMR on OS was observed in all subgroup with different sample size, type of publication, NOS score, and the cut-off value of LMR. In addition, low LMR was significantly correlated with TNM stage and BCLC stage. We therefore conclude that elevated pretreatment LMR could be a favorable prognostic factor for clinical outcomes in patients with HCC.

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Section: Resultsmentioning

confidence: 99%

The pretreatment lymphocyte to monocyte ratio predicts clinical outcome for patients with hepatocellular carcinoma: A meta-analysis

Song

Tian

Wang

et al. 2017

Sci Rep

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“…(14)(15)(16) Moreover, the lymphocyte-to-monocyte ratio (LMR) predicts poor survival of patients with certain cancers including HCC. (17)(18)(19)(20)(21) However, we are unaware of any report that demonstrates the prognostic significance of the LMR for patients who underwent LT for HCC.…”

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confidence: 99%

Lymphocyte‐to‐Monocyte Ratio Is a Predictor of Survival After Liver Transplantation for Hepatocellular Carcinoma

et al. 2018

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Recent studies revealed that systemic inflammation was correlated with poorer prognosis in various cancers. We investigated the prognostic value of the lymphocyte-to-monocyte ratio (LMR) in patients who underwent living donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC). We retrospectively analyzed the records of 216 patients who underwent LDLT for HCC. Patients were divided into high (n = 126) and low (n = 90) LMR groups. Their clinicopathological parameters and survival times were compared. To determine the mechanisms of the change in the LMR, we performed immunohistochemical analyses of CD3 and CD68 expression. A low LMR was significantly associated with a high Model for End-Stage Liver Disease score; a high Child-Pugh score; elevation of alpha-fetoprotein, des-gamma-carboxyprothrombin, and neutrophil-to-lymphocyte ratio; larger tumor size; more tumors; and poorer prognosis. A low LMR was associated with poor prognosis and represented an independent prognostic factor, particularly among patients beyond the Milan criteria. The ratio of CD3-positive to CD68-positive cells was significantly lower in the low-LMR group. In conclusion, our results show that the LMR was an independent predictor of survival of patients with HCC beyond the Milan criteria who underwent LDLT. The LMR reflected the immune status of the tumor microenvironment.

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“…However, previous studies just implemented univariate and/or multivariate analysis on account of unbalanced clinical parameters among groups with distinct outcomes, where over fitting is common because of covariate selection . In this regard, even multiple analysis might give rise to relatively unreliable results . Herein we performed PSM, for the first time, to examine the predictive impact of NLR of 90‐day mortality in our large scale cohort.…”

Section: Discussionmentioning

confidence: 99%

“…1,8,9 In this regard, even multiple analysis might give rise to relatively unreliable results. 10 Herein we performed PSM, for the first time, to examine the predictive impact of NLR of 90-day mortality in our large scale cohort. We found that NLR > 8.9 was a favourable cut-off for identifying LC at high risk, controlling for the influences of potential confounders and selection bias after PSM.…”

Section: Discussionmentioning

confidence: 99%

Prognostic impact of neutrophil‐to‐lymphocyte ratio in cirrhosis: A propensity score matching analysis with a prespecified cut‐point

Deng

Fan

Ran

et al. 2019

Liver International

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Background & Aims An elevated neutrophil‐to‐lymphocyte ratio (NLR) has received attention as a prognostic surrogate across chronic liver diseases. However, an exact threshold has not been fully elucidated. Methods A total number of 589 patients with cirrhosis (LC) were included. The value of NLR was calculated and its optimal cut‐off was initially determined by X‐tile program. Independent predictors of 90‐day mortality were identified with Cox regression model. The Kaplan‐Meier method was used to generate survival curves. To reduce influences of selection bias and possible confounders, a 1:2 propensity score matching (PSM) was performed. Results The X‐tile indicated that the difference in survival was most significant for NLR more than 8.9. Serum NLR > 8.9 was an independent indicator in the entire cohort and PSM subset (HR 4.268, 95% CI 2.211‐8.238, P < .001; HR 4.209, 95% CI 1.448‐12.238, P = .008 respectively). Subgroup analysis showed that NLR > 8.9 was an independent risk factor of 90‐day mortality regardless of age, gender, CTP or MELD score. Conclusions The value of NLR more than 8.9 is a feasible cut‐off across clinical settings among applicable population. The adding of NLR to other conventional predictive systems has the potential to provide incremental value without extra economic cost.

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Lymphocyte to monocyte ratio and neutrophil to lymphocyte ratio are superior inflammation‐based predictors of recurrence in patients with hepatocellular carcinoma after hepatic resection

Abstract: Both LMR and NLR might be preferable independent prognostic factors for DFS in HCC patients undergoing hepatectomy.

Cited by 56 publications

References 43 publications

The pretreatment lymphocyte to monocyte ratio predicts clinical outcome for patients with hepatocellular carcinoma: A meta-analysis

The pretreatment lymphocyte to monocyte ratio predicts clinical outcome for patients with hepatocellular carcinoma: A meta-analysis

Lymphocyte‐to‐Monocyte Ratio Is a Predictor of Survival After Liver Transplantation for Hepatocellular Carcinoma

Prognostic impact of neutrophil‐to‐lymphocyte ratio in cirrhosis: A propensity score matching analysis with a prespecified cut‐point

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