Role of neutrophil to lymphocyte ratio in the prognosis of patients with hepatitis B virus-related hepatocellular carcinoma after operation

Objective To investigate the role of preoperative peripheral blood neutrophil to lymphocyte ratio (NLR) in the prognosis of patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) after operation. Methods Clinical data of 299 patients with HBV-related HCC who underwent radical liver resection in Department of Hepatobiliary Surgery, the Affiliated Hospital of Medical College, Qingdao University from January 2005 to December 2010 were analyzed retrospectively. The informed consents of all patients were obtained and the ethical committee approval was received. There were 258 males and 41 females with age ranging from 23 to 82 years old and median age of 54 years old. NLR was calculated according to the blood routine examination result of peripheral blood collected 3 days before operation. All patients were regularly followed up after operation and the survival and tumor recurrence were recorded. Receiver operating characteristic (ROC) curve of NLR for diagnosing tumor recurrence was plotted and the cut-off value was defined. The patients were divided into low NLR group and high NLR group according to the cut-off value of NLR. The differences of cumulative survival rates and disease-free survival rates between two groups were compared. Clinical parameters were included as the factors influencing patients' 5-year cumulative survival rates and independent risk factors were analyzed. The survival analysis was conducted using Kaplan-Meier method and Log-rank test. Independent risk factor analysis was conducted using Cox proportional-hazards regression model. Results When the cut-off value of NLR for diagnosing tumor recurrence after operation was defined at 1.71, the sensitivity was 0.49 and specificity was 0.73. The 1, 3, 5-year cumulative survival rates were 90.8%, 82.6%, 61.8% in low NLR group (n=173) and was 83.3%, 72.2%, 46.2% in high NLR group (n=126), and the 1, 3, 5-year disease-free survival rates were 82.8%, 66.7%, 44.9% and 62.7%, 36.2%, 24.8% respectively. There were significant differences between two groups in cumulative survival rates and disease-free survival rates (χ2= 6.987, 19.970; P 1.71, gamma-glutamyl transpeptidase (GGT)>64 U/L, alpha fetal protein (AFP)≥400 μg/L and tumor diameter>5 cm (RR=1.504, 0.590, 1.540, 0.982; P<0.05). Conclusions The preoperative NLR is an independent risk factor for influencing the prognosis of patients with HBV-related HCC. Patients with preoperative NLR>1.71 have poor prognosis. Key words: Carcinoma, hepatocellular; Hepatectomy; Neutrophil to lymphocyte ratio; Survival analysis; Prognosis