title: Preoperative neutrophil-to-lymphocyte ratio is a predictor of recurrence following thermal ablation for recurrent hepatocellular carcinoma: a retrospective analysis.
abstract: OBJECTIVE
  The aim of this study is to determine the predictive value of preoperative blood neutrophil-to-lymphocyte ratio (NLR) for recurrence in recurrent hepatocellular carcinoma (RHCC) patients following thermal ablation.
  
  
  METHODS
  This retrospective study enrolled 506 RHCC patients who underwent thermal ablation from April 2006 to April 2014. The clinicopathological parameters including NLR were evaluated to identify predictors of recurrence rate after thermal ablation. A Cox multiple regression analysis was performed to determine the parameters that predicted recurrence in RHCC patients. The best cutoff value of NLR was determined with time-dependent receiver operating characteristic (ROC) curve analysis. The recurrence-free survival (RFS) rate was determined in patients with high and low NLR.
  
  
  RESULTS
  The multivariate Cox proportional hazard model analysis showed that NLR was a prognostic factor in recurrence-free survival. NLR ≥ 2.14 was evaluated (AUROC = 0.824; P<0.001), and 183 of 506 patients (36.2%) had a NLR of more than 2.14. During the follow-up period (12-96 months), the 1-, and 3- year recurrence rates were 20.7% and 31.6% in low NLR group, respectively. These recurrence rates were significantly less than those in the high NLR group (57.9% and 82.5%, respectively) (P<0.001). A recurrence-free survival analyses demonstrated that the RFS in the low NLR group (67.2%) was significantly higher than that in the high NLR group (13.1%) (P<0.001).
  
  
  CONCLUSIONS
  Our results show that preoperative NLR is a predictor for re-recurrence after thermal ablation in RHCC patients. Additionally, patients with NLR <2.14 have a lower recurrence rate, which may improve the clinical management of RHCC patients.
authors.affiliation: Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.
authors.forename: Zhiyu
authors.initials: Z
authors.lastname: Han
authors.affiliation: Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.
authors.forename: Zhigang
authors.initials: Z
authors.lastname: Cheng
authors.affiliation: Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Yu
authors.affiliation: Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.
authors.forename: Shirong
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.
authors.forename: Xiaoling
authors.initials: X
authors.lastname: Yu
authors.affiliation: Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Liang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000401:mortality / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000401:mortality / Q000601:surgery; D018655:Lymphocyte Count; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000401:mortality / Q000601:surgery; D009504:Neutrophils; D011300:Preoperative Care; D012189:Retrospective Studies; D015996:Survival Rate