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Research Article
João Paulo Maciel Silva
Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
Corresponding Author
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Background
Recent studies from eastern centers have demonstrate an association between inflammatory response and long-term outcomes after hepatocellular carcinoma (HCC) resection. However, the prognostic impact of inflammatory markers in western patients, with distinct tumor and epidemiologic features, is still unknown.
Aim
To evaluate the prognostic impact of preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), as well as their impact according to tumor size (< 5 cm, 5-10 cm, > 10 cm) in patients undergoing HCC resection with curative intent.
Methods
Optimal cut-off values for NLR, PLR, and MLR were determined by plotting the receiver operator curves. Overall survival (OS) and disease-free survival (DFS) curves were calculated using the Kaplan-Meier method and compared using the log-rank test. The Cox method was used to identify independent predictors of OS and DFS.
Results
In total, 161 consecutive adult patients were included. A high NLR (>1.715) was associated with worse OS (P=0.018). High NLR (>2.475; P=0.047) and PLR (>100.25; P=0.028) were predictors of short DFS. In HCC < 5 cm, MLR (>1.715) was associated with worse OS (P=0.047). In the multivariate analysis, high PLR was an independent predictor of worse DFS (hazard ratio [HR]=3.029; 1.499-6.121; P=0.002).
Conclusions
Inflammatory markers are useful tools to predict long-term outcomes after liver resection in western patients, high NLR was able to stratify subgroups of patients with short OS and DFS, an increased PLR was an independent predictor of short DFS, while high MLR was associated with short OS in patients with early HCC.
Keywords
Hepatectomy, Hepatocellular Carcinoma, Inflammation, Prognosis, Survival Analysis
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No competing interests reported.
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This preprint is under consideration at BMC Surgery. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
João Paulo Maciel Silva
Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 11 Nov, 2021
No community comments so far
Editor invited
On 09 Nov, 2021
Submission checks complete
On 09 Nov, 2021
First submitted
On 02 Nov, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Recent studies from eastern centers have demonstrate an association between inflammatory response and long-term outcomes after hepatocellular carcinoma (HCC) resection. However, the prognostic impact of inflammatory markers in western patients, with distinct tumor and epidemiologic features, is still unknown.
Aim
To evaluate the prognostic impact of preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), as well as their impact according to tumor size (< 5 cm, 5-10 cm, > 10 cm) in patients undergoing HCC resection with curative intent.
Methods
Optimal cut-off values for NLR, PLR, and MLR were determined by plotting the receiver operator curves. Overall survival (OS) and disease-free survival (DFS) curves were calculated using the Kaplan-Meier method and compared using the log-rank test. The Cox method was used to identify independent predictors of OS and DFS.
Results
In total, 161 consecutive adult patients were included. A high NLR (>1.715) was associated with worse OS (P=0.018). High NLR (>2.475; P=0.047) and PLR (>100.25; P=0.028) were predictors of short DFS. In HCC < 5 cm, MLR (>1.715) was associated with worse OS (P=0.047). In the multivariate analysis, high PLR was an independent predictor of worse DFS (hazard ratio [HR]=3.029; 1.499-6.121; P=0.002).
Conclusions
Inflammatory markers are useful tools to predict long-term outcomes after liver resection in western patients, high NLR was able to stratify subgroups of patients with short OS and DFS, an increased PLR was an independent predictor of short DFS, while high MLR was associated with short OS in patients with early HCC.
Figure 1
Figure 2
No competing interests reported.
This is a list of supplementary files associated with this preprint. Click to download.
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