title: Postoperative neutrophil-to-lymphocyte ratio change predicts survival of patients with small hepatocellular carcinoma undergoing radiofrequency ablation.
abstract: BACKGROUND
  An elevated preoperative neutrophil-to-lymphocyte ratio (NLR) has been reported to be a prognostic factor for hepatocellular carcinoma (HCC) patients after treatment. However, the clinical implication of postoperative NLR change remains unclear.
  
  
  METHODS
  From May 2005 to Aug 2008, a cohort of consecutive 178 small HCC patients treated with radiofrequency ablation (RFA) was retrospectively reviewed. The NLR was recorded within 3 days before and 1 month after RFA. Baseline characteristics, overall survival (OS) and recurrence free survival (RFS) were compared according to preoperative NLR and/or postoperative NLR change. Prognostic factors were assessed by multivariate analysis.
  
  
  RESULTS
  Compared with preoperative NLR level, postoperative NLR decreased in 87 patients and increased in 91 patients after RFA. No significant differences were identified between two groups in commonly used clinic-pathologic features. The 1, 3, 5 years OS was 98.8%, 78.6%, 67.1% for NLR decreased group, and 92.2%, 55.5%, 35.4% for NLR increased group respectively (P<0.001); the corresponding RFS was 94.2%, 65.2%, 33.8% and 81.7%, 46.1%, 12.4% respectively (P<0.001). In subgroup analysis, the survival of patients with lower or higher preoperative NLR can be distinguished more accurate by postoperative NLR change. Multivariate analysis showed that postoperative NLR change, but not preoperative NLR, was an independent prognostic factor for both OS (P<0.001, HR = 2.39, 95%CI 1.53-3.72) and RFS (P = 0.003, HR = 1.69, 95%CI 1.87-8.24).
  
  
  CONCLUSIONS
  The postoperative NLR change was an independent prognostic factor for small HCC patient undergoing RFA, and patients with decreased NLR indicated better survival than those with increased NLR.
authors.affiliation: Department of Hepatobiliary Surgery, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
authors.forename: Jiaqiang
authors.initials: J
authors.lastname: Dan
authors.forename: Yaojun
authors.initials: Y
authors.lastname: Zhang
authors.forename: Zhenwei
authors.initials: Z
authors.lastname: Peng
authors.forename: Junting
authors.initials: J
authors.lastname: Huang
authors.forename: Hengjun
authors.initials: H
authors.lastname: Gao
authors.forename: Li
authors.initials: L
authors.lastname: Xu
authors.forename: Minshan
authors.initials: M
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000401:mortality* / Q000601:surgery; D017115:Catheter Ablation; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008113:Liver Neoplasms / Q000097:blood* / Q000401:mortality* / Q000601:surgery; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies