title: Neutrophil-to-lymphocyte ratio as a predictor of outcomes for patients with hepatocellular carcinoma: a Western perspective.
abstract: OBJECTIVE
  Neutrophil-to-lymphocyte ratio (NLR) is simple, inexpensive, and has been proposed to be predictive in hepatocellular carcinoma (HCC) in Europe and Asia. We aimed to evaluate whether NLR at presentation in a Western center provides any prognostic value compared to other common prognostic scores.
  
  
  METHODS
  NLR was calculated for 75 consecutive patients at presentation with HCC and regression models were used to analyze its value for predicting treatment strategy and short-term survival with Child-Pugh and Model for End Stage Liver Disease (MELD).
  
  
  RESULTS
  NLR was not predictive of future treatment regimens with hepatectomy, liver transplant, or transarterial chemoembolization (TACE; odds ratio [OR]: 0.85, 95% confidence interval [CI]: 0.71-1.02, P = 0.079) as compared the predictive value of MELD (OR: 0.81, CI: 0.72-0.93, P = 0.002) or Child-Pugh (OR: 0.48, CI: 0.34-0.69, P < 0.001). Adding additional adjustment for treatment, NLR did not correlate with short-term overall survival (hazard ratio [HR]: 1.09, CI: 0.95-1.24, P = 0.227). MELD also did not correlate with overall survival (HR: 1.04, CI: 0.96-1.13, P = 0.357) whereas Child-Pugh (HR: 1.56, CI: 1.10-2.19, P = 0.011) was predictive.
  
  
  CONCLUSIONS
  This study does not support the prognostic value of NLR to guide therapy for HCC in a Western center, whereas MELD and Child-Pugh score were more predictive.
authors.affiliation: Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Sullivan
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Groeschl
authors.forename: Kiran K
authors.initials: KK
authors.lastname: Turaga
authors.forename: Susan
authors.initials: S
authors.lastname: Tsai
authors.forename: Kathleen K
authors.initials: KK
authors.lastname: Christians
authors.forename: Sarah B
authors.initials: SB
authors.lastname: White
authors.forename: William S
authors.initials: WS
authors.lastname: Rilling
authors.forename: Charles H C
authors.initials: CH
authors.lastname: Pilgrim
authors.forename: T Clark
authors.initials: TC
authors.lastname: Gamblin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology*; D011379:Prognosis; D012720:Severity of Illness Index; D055815:Young Adult
keywords: hepatocellular carcinoma; inflammation; neutrophil-to-lymphocyte ratio