Neutrophil–lymphocyte ratio predicts overall and recurrence‐free survival after liver transplantation for hepatocellular carcinoma

Abstract

Aims The goal of this study is to evaluate whether an elevated neutrophil-lymphocyte ratio (NLR) at the time of diagnosis predicts survival of patients with hepatocellular carcinoma (HCC) after liver transplant (LT). We hypothesize that the NLR is predictive of overall survival (OS) and recurrence-free survival (RFS) in patients with HCC who undergo LT. Methods This is a retrospective analysis of adult patients undergoing LT for HCC between 2000 and 2008 at our institution. We define an elevated NLR as a ratio of five or greater. Results We included 160 patients who underwent LT for HCC in the time period, of whom 28 had an elevated NLR. Seventeen subjects experienced recurrent HCC during the study period. The cumulative survival among subjects with an elevated NLR was significantly lower than among subjects with a normal NLR. On univariate analysis, several factors (including an elevated NLR) predicted decreased overall survival and recurrence-free survival. However, after multivariate analysis, only three factors (including elevated NLR) remained significant as predictors of overall survival. Additionally, multivariate analysis revealed that an elevated NLR was the only significant independent predictor of recurrence-free survival. Conclusions Preoperative NLR is a powerful independent predictor of overall survival and recurrence-free survival in patients undergoing LT for HCC. Measurement of NLR could serve as a useful and easily obtained adjunct to the MELD score and Milan criteria when evaluating this patient population and determining which patients will gain the most survival benefit from transplant.

Radiological response and inflammation scores predict tumour recurrence in patients treated with transarterial chemoembolization before liver transplantation

“…The prognostic performance of NLR and PLR, two simple and easily accessible serum parameters of systemic inflammation, were tested in the clinical scenario of LT, leading to controversial results[29-31,36,37,57-59]. An intention-to-treat study by Lai et al[32] demonstrated that NLR is a good predictor for dropout from the waiting list, while PLR is a good predictor of post-LT recurrence.…”

Immune Imbalances in Non-Alcoholic Fatty Liver Disease: From General Biomarkers and Neutrophils to Interleukin-17 Axis Activation and New Therapeutic Targets

“…In the evolution of patients with HCC undergoing radiofrequency ablation, or surgical resection, a high NLR predicted poor outcomes with higher recurrence and mortality rates (74–77) and poor overall survival even after a curative liver resection (76). And even in those undergoing liver transplantation, a high NLR was associated with poorer overall and recurrence-free survival (78). …”

Liver Transplantation for Advanced Hepatocellular Carcinoma

“…The most frequently investigated parameter is neutrophil-to-lymphocyte ratio (NLR). [70][71][72][73] In 2009, Halazun and colleagues 70 reported that the disease-free survival of patients with high pre-transplant NLR ≥5 was significantly worse than that of patients with low NLR. In addition, the 5-year disease free survival of patients within the Milan criteria with NLR ≥5 was only 30%, while that of patients beyond the Milan criteria with NLR <5 was 60%.…”