The Value Of Preoperative Neutrophil To Lymphocyte Ratio On Predicting Prognosis Of Patients With HBV-Related Hepatocellular Carcinoma After R0Resection

Object:In this retrospectively paper, we studied the optimal cut-off neutrophil to lymphocyte ratio (NLR) value to predict prognosis of patients with HBV-related HCC underwent RO resection.Methods:Two hundred ninety-nine patients with HBV-related HCC underwent RO resection in Affiliated Hospital of Medical College, Qingdao University from January2005to December2010were collected as the research objects in this study. The protocol was approved by the ethics committee (ethics committee of Affiliated Hospital of Medical College, Qingdao University), and written informed consent was obtained from all study participants. Two hundred and fifty-eight were males, forty-one were females, the mean age of patients at surgery was54years (range:23-82years). The whole blood analysis was examed3days before surgery, the NLR was defined as the absolute neutrophil count divided by the absolute lymphocyte count. A suitable cut-off value for high NLR was selected by the Receiver Operating Characteristic (ROC) curve analysis. After RO resection, patients were regularly followed up at the outpatient clinics. All patients were divided into high NLR group and normal NLR group according to the cut-off value. The independent samples t test and Pearson’s chi-square (χ2) test were used to analyze differences in basic factors such as gender, age, pre-operative PLT level, pre-operative ALB, AST, GGT, TB, AFP level, tumor size, tumor numbers, cirrhosis, portal hypertension, anatomical hepatectomy, Pringle’s maneuver, haemorrhage, transfusion and so on. The patients’overall survival (OS) rate and disease-free survival (DFS) rate between high NLR group and normal group was analyzed by Kaplan-Meier method (log rank test), and the dependent risk factors for OS rate and DFS rate were analyzed by Cox regression analysis.Result:The NLR value was1.71,determined by Youden index, used the preoperative NLR as the test variable, tumor recurrence as the state variable. The sensitivity was49.4%, specificity was72.9%.Compared with low NLR group, high NLR group total bilirubin levels and tumor diameter>5cm significantly increased. The survival rate of NLR>1.71group was significantly lower than that of NLR<1.71group patients.High NLR value, GGT>64U/L, AFP>400ng/mL and tumor diameter of>5cm were risk factors for affecting the overall survival rates of HBV associated with HCC in patients with RO resection (p<0.05). The cut-off value of NLR was1.71. NLR had significant Statistics correlated with pre-operative TBil level and tumor size (χ2=163.062,8.512; P<0.05). By Kaplan-Meier method analysis, the1,3,5-yr OS rate of normal NLR and high NLR was90.8%,82.6%,61.8%and83.3%,72.2%,46.2%, the1,3,5-yr DFS rate of normal NLR and high NLR was82.8%,66.7%,44.9%and62.7%,36.2%,24.8%(χ2=6.987,19.97; P<0.05). NLR was the independent frisk factors for5yr-OS rate (RR=1.504, P<0.05)Conclusions:The high NLR group patients, preoperative AFP>400ng/mL, GGT>64U/L and tumor diameter of>5cm were the independent risk factors for overall survival in patients with HCC,the high NLR group had a poor prognosis after RO resection. Attention should be paid to the comprehensive treatment of such patients.