| Background:Hepatocellular carcinoma (HCC) is a common malignant tumor, which remains a serious threat to human health. Liver transplantation is a kind of radical cure methods of liver cancer. In recent years, studies have shown that elevated level of preoperative neutrophil-lymphocyte ratio (NLR) is associated with poor prognosis after liver transplantation. The purpose of our study is to confirm the optimal NLR cut-off value, analyze long-term outcomes of HCC patients after liver transplantation, further establish a model based on NLR, and discuss potential values of this model in aspect of selection criteria and prognosis evaluation for HCC recipients.Methods:We retrospectively analyzed data of249HCC patients who received transplantation from Jan,2002to Dec,2012in Liver Transplantation Center, the First Affiliated Hospital of Zhejiang University. To estimate whether or not NLR was an independent prognostic factor in terms of overall and tumor free survival with univariate and multivariate analyses. To confirm the optimal NLR cut-off value, divide249HCC patients into two groups and analyze long-term outcomes of HCC patients after liver transplantation to determine differences between groups. To analyze overall and tumor free survival of HCC recipients by NLR based model to determine the differences. Survival curves were determined by the Kaplan-Meier method and tested by the log-rank statistic. Outcomes of univariate analysis were entered into a multivariate COX regression model to determine the independent effect.Results:Univariate and multivariate analyses showed that NLR was an independent prognostic factor in terms of overall and tumor free survival for HCC recipients. The optimal NLR cut-off value was6and of249HCC recipients involved in our study,30recipients had NLR>6. The overall survival (OS) for recipients with NLR≤6was significantly better than that for recipients with NLR>6(1-year,3-year,5-year OS was83.6%vs.50.0%,64.5%vs.42.3%,54.2%vs.32.2%; P<0.001). The tumor free survival (TFS) for recipients with NLR<6was significantly better than that for recipients with NLR>6(1-year,3-year,5-year TFS was63.0%vs.40.0%,52.3%vs.30.0%,48.0%vs.25.7%; P=0.001). Subsequently, we established NLR based models OS_Y and TFS_Y according to multivariate analysis. The area under ROC curve of OS_Y was0.807and the optimal cut-off value was1.67. There is no significant difference of OS between recipients exceeding Hangzhou Criteria but OS_Y≤1.67and recipients within Hangzhou Criteria (1-year,3-year,5-year OS was82.6%vs.90.1%,67.4%vs.81.2%,67.4%vs.71.3%; P=0.445). For those exceeding Hangzhou Criteria, OS for recipients with OS_Y≤1.67was significantly better than that for recipients with OS_Y>1.67(1-year,3-year,5-year OS was82.6%vs.60.7%,67.4%vs.24.5%,67.4%vs.13.8%; P<0.001). The area under ROC curve of TFS_Y was0.785and the optimal cut-off value was-0.01. There is similar TFS between recipients with TFS_Y≤-0.01and recipients within Hangzhou Criteria (1-year,3-year,5-year TFS was77.6%vs.80.3%, 69.5%vs.69.5%,65.9%vs.64.3%). However, TFS for recipients exceeding Hangzhou Criteria but TFS_Y<-0.01was worse than that of recipients within Hangzhou Criteria (1-year,3-year,5-year TFS was51.5%vs.80.3%,44.4%vs.69.5%,44.4%vs.64.3%; P=0.004). For those exceeding Hangzhou Criteria, TFS for recipients with TFS_Y<-0.01was significantly better than that for recipients with TFS_Y>1.67(1-year,3-year,5-year TFS was51.5%vs.25.7%,44.4%vs.13.6%,44.4%vs.8.5%; P<0.001).Conclusions:Pre-transplant neutrophil-lymphocyte ratio is an independent risk factor that affects the prognosis of HCC patients after liver transplantation. Elevated NLR significantly reduces long-term survival and increases the risk of recurrence of HCC patients after liver transplantation. The model based on NLR could aid in pre-transplant prognosis evaluation of HCC recipients. |
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