Neutrophil-to-lymphocyte Ratio （NLR） Dynamic Changes On Survival Analysis After Liver Transplantation For Hepatitis B-associated Hepatocellular Carcinoma

Objective:To explore the predictive value of dynamic changes in neutrophil-to-lymphocyte ratio（NLR）on tumor recurrence rate and patient survival after liver transplantation for hepatitis B-associated hepatocellular carcinoma.METHODS:A retrospective analysis was performed on patients with hepatitis B-related hepatocellular carcinoma（HBV-HCC）who underwent orthotopic liver transplantation at the First Hospital of Jilin University from January 2014 to December 2019.Patients were divided into recurrence group（n=36）and recurrence-free group（n=57）according to tumor recurrence after liver transplantation,and clinical data and disease-free survival（DFS）were statistically compared between the two groups,and logistic regression was used to identify risk factors for recurrence.Risk factors affecting patients’ overall survival（OS）were analyzed using Cox regression models.The values of NLR 1 day before and 1 month and 3months after liver transplantation were also recorded,and the patients were divided into continuously decreasing group（CD）,volatility change group（VC）and continuously rise group（CR）according to the preoperative and postoperative changes,and the survival of each group was compared by Kaplan-Meier.Result:（1）The results of t-test or chi-square test for demographic and clinical data in the recurrence group and the no recurrence group showed that there was statistically significant preoperative AFP,maximum tumor diameter,microvascular invasion（MVI）,and TNM stage in the recurrence group and the no recurrence group（P<0.05）.Neutrophil count,lymphocyte count and NLR before surgery,neutrophil count,lymphocyte count and NLR at 1 month after surgery,and neutrophil count,lymphocyte count and NLR at 3 months after surgery were statistically significant（P<0.05）.（2）Logistic regression model results showed that MVI（P=0.011,OR=18.127,95% CI1.949-168.622）,maximum tumor diameter（P=0.016,OR=1.499,95% CI 1.077-2.087）,preoperative NLR（P=0.028,OR=2.393,95% CI 1.098-5.214,）and 1-month postoperative NLR（P=0.010,OR=1.972,95% CI 1.175-3.309）were risk factors for tumor recurrence after transplantation.（3）The results of one-way Cox regression analysis showed that pre-transplantation alpha-fetoprotein（AFP）,tumor number,maximum tumor diameter,MVI,TNM stage,pre-transplantation neutrophil count,lymphocyte count,NLR,1-month post-transplantation neutrophil count,lymphocyte count,NLR,3-month post-transplantation neutrophil count,lymphocyte count and NLR were associated with patient prognosis OS was correlated（P<0.05）.Multi-factor Cox regression model analysis showed that none of the above relevant variables were risk factors for patient prognosis（P>0.05）.（4）Kaplan-Meier survival curves showed that patients in the CR group had a significantly shorter DFS than those in the CD group（log-rank test,P<0.0001）and a significantly shorter OS in the CR group than those in the CD group（log-rank test,P<0.05）.Conclusion:MVI,maximum tumor diameter,preoperative NLR and NLR at 1 month after liver transplantation were risk factors for tumor recurrence after receiving allogeneic in situ liver transplantation;persistently elevated NLR after liver transplantation predicted poorer OS and DFS.