title: Neutrophil-to-lymphocyte ratio predicts recurrence after radiofrequency ablation in hepatitis B virus infection.
abstract: OBJECTIVE
  Radiofrequency ablation (RFA) is an established treatment for small hepatocellular carcinoma (HCC) wherein non-recurrence is essential for long-term survival. Recently, neutrophil-to-lymphocyte ratio (NLR), a marker of systemic inflammation that is associated with tumor-associated macrophages (TAMs), was suggested to be a prognostic marker of HCC treated with RFA. Therefore, we evaluated predictive factors, including NLR, associated with recurrence after curative RFA.
  
  
  METHODS
  A total of 163 patients initially diagnosed with HCC and treated with RFA were enrolled. We retrospectively analyzed factors associated with recurrence and survival after RFA. Furthermore, TAMs were evaluated using surgically resected specimens.
  
  
  RESULTS
  Hepatitis C virus (HCV) infection was the most frequent cause of HCC in this population (111 cases, 68.1%), whereas hepatitis B virus (HBV) infection accounted for 26 cases (16.0%). Recurrence, mostly intrahepatic distant recurrence, was found in 101 cases (61.9%). Recurrence and posttreatment NLR were independent prognostic factors related to survival, and male sex, HCV infection, serum des-γ-carboxy prothrombin >  40 AU/L, and posttreatment NLR were associated with recurrence. Pretreatment NLR showed no association with recurrence, whereas posttreatment NLR showed prognostic value. Interestingly, pretreatment NLR >  2.5 was significantly associated with recurrence in HBV-HCC patients (odds ratio 3.439, P = 0.037) not but HCV-HCC (odds ratio 1.430, P = 0.17). Furthermore, TAMs were increased in the peripheral area of HCCs with HBV infection compared with those with HCV.
  
  
  CONCLUSIONS
  Recurrence of HCC after RFA was strongly associated with survival. NLR is useful as a predictive marker of recurrence, especially in HBV-HCC patients.
authors.affiliation: The Third Department of Internal Medicine, Toyama University Hospital, Toyama, Japan.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Tajiri
authors.affiliation: The Third Department of Internal Medicine, Toyama University Hospital, Toyama, Japan.|Diagnostic Pathology, Faculty of Medicine, University of Toyama, Toyama, Japan.
authors.forename: Hayato
authors.initials: H
authors.lastname: Baba
authors.affiliation: The Third Department of Internal Medicine, Toyama University Hospital, Toyama, Japan.
authors.forename: Kengo
authors.initials: K
authors.lastname: Kawai
authors.affiliation: The Third Department of Internal Medicine, Toyama University Hospital, Toyama, Japan.
authors.forename: Masami
authors.initials: M
authors.lastname: Minemura
authors.affiliation: The Third Department of Internal Medicine, Toyama University Hospital, Toyama, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yasumura
authors.affiliation: The Third Department of Internal Medicine, Toyama University Hospital, Toyama, Japan.
authors.forename: Terumi
authors.initials: T
authors.lastname: Takahara
authors.affiliation: The Third Department of Internal Medicine, Toyama University Hospital, Toyama, Japan.
authors.forename: Toshiro
authors.initials: T
authors.lastname: Sugiyama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000601:surgery* / Q000821:virology; D017115:Catheter Ablation; D005260:Female; D006509:Hepatitis B / Q000150:complications*; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D007958:Leukocyte Count; D008113:Liver Neoplasms / Q000601:surgery* / Q000821:virology; D008214:Lymphocytes; D008264:Macrophages; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009504:Neutrophils; D011237:Predictive Value of Tests; D011379:Prognosis
chemical_list: D014408:Biomarkers, Tumor
keywords: hepatocellular carcinoma; neutrophil-to-lymphocyte ratio; radiofrequency ablation; recurrence; tumor-associated macrophage