title: Neutrophil and platelet-to-lymphocyte ratio as new predictors of dropout and recurrence after liver transplantation for hepatocellular cancer.
abstract: There is increasing evidence that systemic inflammation markers like neutrophil (NLR) and platelet-to-lymphocyte ratios (PLR) may play a role in the outcome of hepatocellular cancer (HCC). Between January 1994 and March 2012, 181 patients with HCC were registered on the transplant waiting list: 35 (19.3%) patients dropped out during the waiting period and 146 (80.7%) patients underwent liver transplantation (LT). The median follow-up of this patient cohort was 4.2 years (IQR: 1.8-8.3). On c-statistics, the last NLR (AUROC = 67.4; P = 0.05) was the best predictor of dropout. The last PLR had an intermediate statistical ability (AUROC = 66.1; P = 0.07) to predict post-LT tumor recurrence. Patients with a NLR value >5.4 had poor 5-year intention-to-treat (ITT) survival rates (48.2 vs. 64.5%; P = 0.02). Conversely, PLR better stratified patients in relation to tumor-free survival (TFS) (80.7 vs. 91.6%; P = 0.02). NLR is a good predictor for the risk of dropout, while PLR is a good predictor for the risk of post-LT recurrence. Use of these markers, which are all available before LT, may represent an additional tool to refine the selection criteria of HCC liver recipients.
authors.affiliation: Starzl Unit of Abdominal Transplantation, University Hospitals St. Luc, Université catholique Louvain - UCL, Brussels, Belgium; Department of Hepatic Surgery and Liver Transplantation, Azienda Universitario-ospedaliera Pisana, Pisa, Italy.
authors.forename: Quirino
authors.initials: Q
authors.lastname: Lai
authors.forename: Edward
authors.initials: E
authors.lastname: Castro Santa
authors.forename: Juan M
authors.initials: JM
authors.lastname: Rico Juri
authors.forename: Rafael S
authors.initials: RS
authors.lastname: Pinheiro
authors.forename: Jan
authors.initials: J
authors.lastname: Lerut
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000032:analysis; D001792:Blood Platelets / Q000473:pathology*; D006528:Carcinoma, Hepatocellular / Q000473:pathology*; D005260:Female; D006509:Hepatitis B / Q000821:virology; D006526:Hepatitis C / Q000821:virology; D006801:Humans; D007249:Inflammation / Q000473:pathology; D008113:Liver Neoplasms / Q000473:pathology*; D016031:Liver Transplantation / Q000401:mortality*; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology; D009504:Neutrophils / Q000473:pathology*; D010352:Patient Dropouts; D011379:Prognosis; D014850:Waiting Lists; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D015415:Biomarkers; D000509:alpha-Fetoproteins
keywords: Milan criteria; alpha-fetoprotein; inflammatory markers; lymphocytes; neutrophils; platelets