title: Stratified neutrophil-to-lymphocyte ratio accurately predict mortality risk in hepatocellular carcinoma patients following curative liver resection.
abstract: OBJECTIVE
  Neutrophil lymphocyte ratio (NLR) has been shown to predict prognosis of cancers in several studies. This study was designed to evaluate the impact of stratified NLR in patients who have received curative liver resection (CLR) for hepatocellular carcinoma (HCC).
  
  
  METHODS
  A total of 1659 patients who underwent CLR for suspected HCC between 2007 and 2014 were reviewed. The preoperative NLR was categorized into quartiles based on the quantity of the study population and the distribution of NLR. Hazard ratios (HRs) and 95% confidence intervals (CIs) were significantly associated with overall survival (OS) and derived by Cox proportional hazard regression analyses. Univariate and multivariate Cox proportional hazard regression analyses were evaluated for association of all independent parameters with disease prognosis.
  
  
  RESULTS
  Multivariable Cox proportional hazards models showed that the level of NLR (HR = 1.031, 95%CI: 1.002-1.060, P = 0.033), number of nodules (HR = 1.679, 95%CI: 1.285-2.194, P<0.001), portal vein thrombosis (HR = 4.329, 95%CI: 1.968-9.521, P<0.001), microvascular invasion (HR = 2.527, 95%CI: 1.726-3.700, P<0.001) and CTP score (HR = 1.675, 95%CI: 1.153-2.433, P = 0.007) were significant predictors of mortality. From the Kaplan-Meier analysis of overall survival (OS), each NLR quartile showed a progressively worse OS and apparent separation (log-rank P=0.008). The highest 5-year OS rate following CLR (60%) in HCC patients was observed in quartile 1. In contrast, the lowest 5-year OS rate (27%) was obtained in quartile 4.
  
  
  CONCLUSIONS
  Stratified NLR may predict significantly improved outcomes and strengthen the predictive power for patient responses to therapeutic intervention.
authors.affiliation: Department of Infection and Liver Diseases, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.|Renji School of Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Gui-Qian
authors.initials: GQ
authors.lastname: Huang
authors.affiliation: Department of Infection and Liver Diseases, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.|School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Gui-Qi
authors.initials: GQ
authors.lastname: Zhu
authors.affiliation: College of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, 325035, China.
authors.forename: Yan-Long
authors.initials: YL
authors.lastname: Liu
authors.affiliation: Department of Infection and Liver Diseases, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.|School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Li-Ren
authors.initials: LR
authors.lastname: Wang
authors.affiliation: Global Medicines Development, AstraZeneca R&D, Alderley Park, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: Braddock
authors.affiliation: Department of Infection and Liver Diseases, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.|Institute of Hepatology, Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Ming-Hua
authors.initials: MH
authors.lastname: Zheng
authors.affiliation: Department of Hepatobiliary Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Meng-Tao
authors.initials: MT
authors.lastname: Zhou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009504:Neutrophils / Q000473:pathology*; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult
keywords: curative liver resection; hepatocellular carcinoma; neutrophil-to-lymphocyte ratio; overall survival