title: How to select suitable hepatocellular carcinoma for liver transplantation by preoperative neutrophil-lymphocyte ratio.
abstract: OBJECTIVE
  The liver transplantation (LT) criteria for hepatocellular carcinoma (HCC) is expanding. However, most of the existing criteria are based on tumor characteristics of radiology. We aimed to build a preoperative scoring model including the neutrophil–lymphocyte ratio (NLR) to select HCC patients for LT.
  
  
  METHODS
  Using receiver operating characteristic curve (ROC) analysis the sensitivity and specificity were highest when NLR was 3.79, so we defined NLR > 4 as elevated. By univariate and multivariate analysis, the significant predictors including NLR were used to establish a scoring model to predict outcome of HCC patients after LT.
  
  
  RESULTS
  Of 280 HCC patients, there were 114 patients with elevated NLR. The one-, three- and five-year recurrence-free survival rates of patients with high and low NLR were 64.9%, 30.1%, 30.1% vs. 83.9%, 62.9%, 60.7% (p < 0.001). On univariate and multivariate analysis, the raised NLR (p = 0.007), total tumor size > 9 cm (p < 0.001) and vascular invasion (p < 0.001) were the significant factors in predicting outcome. By ROC analysis, the patients with a score ≥ 1 had an area under the curve (AUC) of 0.745.
  
  
  CONCLUSIONS
  This scoring model including NLR can aid in selecting HCC candidates for LT.
authors.forename: Guang-Qin
authors.initials: GQ
authors.lastname: Xiao
authors.forename: Lunan
authors.initials: L
authors.lastname: Yan
authors.forename: Jiayin
authors.initials: J
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D018655:Lymphocyte Count; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009504:Neutrophils; D018579:Patient Selection; D011237:Predictive Value of Tests; D012372:ROC Curve; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult