title: Prognostic value of C-reactive protein and neutrophil-to-lymphocyte ratio in patients with hepatocellular carcinoma.
abstract: BACKGROUND
  Accumulating evidence indicates that components of the systemic inflammatory response, such as C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR), have been associated with prognosis of various cancers. We aimed to elucidate whether CRP and NLR could serve as potential surrogate markers for response and survival in patients with hepatocellular carcinoma (HCC).
  
  
  METHODS
  The study population consisted of 318 consecutive patients with HCC. CRP and NLR were measured at baseline with follow-up measurements.
  
  
  RESULTS
  With the mean follow-up of 13.9 months, the median survival time was 13.8 months. Child-Pugh class, tumor size > 5 cm, tumor multiplicity, presence of portal vein thrombosis, α-fetoprotein > 200 ng/mL, CRP > 6.3 mg/L and NLR > 2.3 were identified as independent factors for worse survival of HCC (all p < 0.05). Patients with elevated CRP (> 6.3 mg/L) and elevated NLR (> 2.3) had a significantly shorter overall survival than those with low CRP and low NLR (all p < 0.001). The combined use of CRP and NLR provided incremental prognostic information. With significant inter-correlations, levels of CRP and NLR escalated with aggravating Child-Pugh class from A to C or progressing tumor stage from I to IV. CRP and NLR on baseline and serial measurements were well predictive of treatment response (p < 0.001).
  
  
  CONCLUSIONS
  CRP and NLR are independent indicators for survival in HCC patients, reflecting tumor burden and hepatic reserve. Their role in predicting tumor response and survival is more enhanced when used in combination. This study suggests that CRP and NLR are important prognostic biomarkers for HCC.
authors: Department of Internal Medicine, The Catholic University of Korea, Incheon St, Mary's Hospital, Incheon, Korea.
authors: Byong Sun
authors: BS
authors: Oh
authors: Jeong Won
authors: JW
authors: Jang
authors: Jung Hyun
authors: JH
authors: Kwon
authors: Chan Ran
authors: CR
authors: You
authors: Kyu Won
authors: KW
authors: Chung
authors: Chul Seung
authors: CS
authors: Kay
authors: Hyun Suk
authors: HS
authors: Jung
authors: Seungok
authors: S
authors: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis* / Q000378:metabolism; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000473:pathology; D005260:Female; D006801:Humans; D007723:Korea; D008113:Liver Neoplasms / Q000097:blood* / Q000473:pathology; D008214:Lymphocytes / Q000166:cytology*; D008297:Male; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000097:blood*; D009367:Neoplasm Staging; D009504:Neutrophils / Q000166:cytology*; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies
chemical_list: D014408:Biomarkers, Tumor; D009363:Neoplasm Proteins; D002097:C-Reactive Protein