title: Neutrophil-lymphocyte ratio predicts the prognosis of patients with hepatocellular carcinoma after liver transplantation.
abstract: OBJECTIVE
  To determine whether an elevated neutrophil-lymphocyte ratio (NLR) is negatively associated with tumor recurrence in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) after liver transplantation (LT), and to determine the optimal predictive NLR cut-off value.
  
  
  METHODS
  The data of HCC patients who had undergone LT came from the China Liver Transplant Registry database. We collected data from 326 liver cancer patients who had undergone LT at our medical center. We divided the patients into groups based on their NLRs (3, 4 or 5). We then compared the clinicopathological data and long-time survival between these groups. Meanwhile, we used receiver operating characteristic analysis to determine the optimal NLR cut-off.
  
  
  RESULTS
  Of 280 HCC patients included in this study, 263 were HBV positive. Patients with an NLR < 3 and patients with an NLR ≥ 3 but < 4 showed no significant differences in overall survival (OS) (P = 0.212) or disease-free survival (DFS) (P = 0.601). Patients with an NLR ≥ 4 but < 5 and patients with an NLR ≥ 5 also showed no significant differences in OS (P = 0.208) or DFS (P = 0.618). The 1-, 3- and 5-year OS rates of patients with an NLR < 4 vs an NLR ≥ 4 were 87.8%, 63.8% and 61.5% vs 73.9%, 36.7% and 30.3%, respectively (P < 0.001). The 1-, 3- and 5-year DFS rates of patients with an NLR < 4 vs NLR ≥ 4 were 83.9%, 62.9% and 60.7% vs 64.9%, 30.1% and 30.1%, respectively (P < 0.001). Univariate and multivariate analyses demonstrated that three factors, including NLR ≥ 4 (P = 0.002), were significant predictors of tumor recurrence in HCC patients after LT.
  
  
  CONCLUSIONS
  A preoperative elevated NLR significantly increased the risk for tumor recurrence in HCC patients after LT.
authors.affiliation: Guang-Qin Xiao, Chang Liu, Da-Li Liu, Jia-Yin Yang, Lu-Nan Yan, Department of Liver and Vascular Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Guang-Qin
authors.initials: GQ
authors.lastname: Xiao
authors.affiliation: Guang-Qin Xiao, Chang Liu, Da-Li Liu, Jia-Yin Yang, Lu-Nan Yan, Department of Liver and Vascular Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Chang
authors.initials: C
authors.lastname: Liu
authors.affiliation: Guang-Qin Xiao, Chang Liu, Da-Li Liu, Jia-Yin Yang, Lu-Nan Yan, Department of Liver and Vascular Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Da-Li
authors.initials: DL
authors.lastname: Liu
authors.affiliation: Guang-Qin Xiao, Chang Liu, Da-Li Liu, Jia-Yin Yang, Lu-Nan Yan, Department of Liver and Vascular Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Jia-Yin
authors.initials: JY
authors.lastname: Yang
authors.affiliation: Guang-Qin Xiao, Chang Liu, Da-Li Liu, Jia-Yin Yang, Lu-Nan Yan, Department of Liver and Vascular Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Lu-Nan
authors.initials: LN
authors.lastname: Yan
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000821:virology; D016009:Chi-Square Distribution; D002681:China; D018572:Disease-Free Survival; D005260:Female; D006509:Hepatitis B / Q000150:complications; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D018655:Lymphocyte Count; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009504:Neutrophils; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Hepatitis B virus; Hepatocellular carcinoma; Inflammatory reaction; Liver transplantation; Neutrophil-lymphocyte ratio