title: Prognostic value of preoperative peripheral blood monocyte count in patients with hepatocellular carcinoma.
abstract: BACKGROUND
  The prognostic significance of the leukocyte subsets in peripheral blood has not yet been investigated in hepatocellular carcinoma patients. We sought to clarify the prognostic value of preoperative peripheral blood leukocyte subset counts, especially the absolute monocyte count, in HCC patients who have undergone hepatic resection.
  
  
  METHODS
  We retrospectively examined the relation between the preoperative absolute number of peripheral monocytes and clinicopathologic factors or long-term prognosis in 198 patients with hepatocellular carcinoma who underwent curative resection.
  
  
  RESULTS
  Univariate analysis indicated a significantly worse 5-year disease-free survival rate in patients with a peripheral blood monocyte count > 300/mm(3) (14.8%) than in patients with a count < or = 300/mm(3) (29.2%). There were no significant differences between patients in disease-free survival based on the lymphocyte or neutrophil count. According to multivariate analysis, preoperative peripheral blood monocyte count > 300/mm(3), alpha-fetoprotein level > 100 ng/mL, aspartate aminotransferase level > 100 IU/mL, and presence of microvascular invasion were independent risk factors for disease-free survival of less than 5 years. The peripheral blood monocyte count was higher in patients of male sex or those with a noncirrhotic liver, microvascular invasion, major hepatic resection, older age (>65 years), large tumor (> or =50 mm), or increased platelet count (>100,000/mm(3)) than in patients without these characteristics.
  
  
  CONCLUSIONS
  Our findings indicate that the preoperative absolute count (>300/mm(3)) of peripheral blood monocytes may be related to tumor progression and that it is an independent risk factor for recurrence of hepatocellular carcinoma after resection. Postoperative adjuvant chemotherapy might be necessary in patients with elevation of the preoperative absolute count of peripheral blood monocytes.
authors.affiliation: Department of Surgery I, Oita University Faculty of Medicine, Oita, Japan. sasakia@beppu.kyushu-u.ac.jp
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sasaki
authors.forename: Yukio
authors.initials: Y
authors.lastname: Iwashita
authors.forename: Kohei
authors.initials: K
authors.lastname: Shibata
authors.forename: Toshifuni
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ohta
authors.forename: Seigo
authors.initials: S
authors.lastname: Kitano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000401:mortality / Q000473:pathology; D003713:Dendritic Cells / Q000502:physiology; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007167:Immunotherapy; D007694:Killer Cells, Natural / Q000502:physiology; D007958:Leukocyte Count; D008113:Liver Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000502:physiology*; D011379:Prognosis
chemical_list: D002097:C-Reactive Protein