Background: The prognostic impact of the preoperative neutrophil to lymphocyte ratio (NLR) in patients with non-B, non-C hepatocellular carcinoma (NBNC-HCC) who undergo radical resection is unclear. This study elucidates the prognostic value of NLR in patients undergoing radical resection for NBNC-HCC.
Methods: A total of 212 patients who were treated at the Cancer Center of Sun Yat-sen University from January 1998 to December 2007 were included in this study, and all patients underwent liver tumour resection and had postoperative pathological confirmation of HCC. The 212 patients were divided into four groups according to their NLR and HBsAg. The clinicopathologic and survival characteristics of the patients in Group 4 were compared with those in Groups 1-3.
Results: There were statistically significant differences in age, drinking, body mass index (BMI), diabetes, metabolic syndrome, ALT, AST, tumour size, and secondary tumour (P<0.05) between Group 1 (NBNC-AFP(-) vs. B-AFP(+)). The univariate analysis showed that NLR, BMI, drinking, AST, tumour size, secondary tumour and portal violation (P<0.05) were factors affecting the disease free survival (DFS) in postoperative HCC patients. A Cox multivariate regression analysis showed that tumour size and secondary tumour (p<0.05) were independent factors influencing DFS after surgery. The univariate analysis showed that BMI, AST, tumour size, secondary tumour and portal violation (p<0.05) were factors that affected both DFS and OS in NBNC-NLR (-)-HCC patients after surgery, and in addition, the multifactor analysis using a Cox model showed that NLR, secondary tumour and BMI (p<0.05) were independent influences on the postoperative DFS in patients with NBNC-NLR (-)-HCC. The Kaplan–Meier survival analysis showed that the NBNC-NLR(-)-HCC patients had the highest rate of DFS among the four patient groups (p<0.05). The 1-, 3-, 5- and 10-year DFS rates for the NBNC-NLR(-)-HCC patients were 85.6%, 68.5%, 43.5% and 34.8%, respectively. The NBNC-NLR(-)-HCC patients had a higher postoperative DFS than the B-NLR(+)-HCCNBNC-NLR(+)-HCC and B-NLR(-)-HCC patients (p<0.05). The DFS rates at 1, 3, 5 and 10 years after surgery were 85.6%, 68.5%, 43.5% and 34.8% for the NBNC-NLR (-)-HCC group, respectively.
Conclusion: The preoperative NLR is a valid prognostic indicator for patients with non-B non-C-HCC undergoing radical resection.