title: Significance of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and prognostic nutrition index as preoperative predictors of early mortality after liver resection for huge (≥10 cm) hepatocellular carcinoma.
abstract: BACKGROUND
  This study aimed to determine preoperative predictors of early (<1 year) mortality from disease recurrence after liver resection (LR) for huge (≥10 cm) HCC, with special emphasis on the importance of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and prognostic nutrition index (PNI).
  
  
  METHODS
  Between 2000 to 2013, 166 patients underwent LR for huge HCC. Optimal cut-offs for alpha fetoprotein (AFP), NLR, PLR, and PNI were determined by plotting the receiver operator curves (ROC) in predicting early mortality and utilizing the Youden index.
  
  
  RESULTS
  The 30-day/in-hospital postoperative mortality rate was 4.2%. The 5-year overall survival (OS) and the 5-year recurrence-free survival (RFS) was 43% and 24%, respectively. Early mortality from disease recurrence occurred in 35 of 159 (22%) patients. Multivariate analyses demonstrated that tumor rupture and high AFP (>1,085 ng/ml) were independent preoperative predictors of early mortality after LR for HCC, and both a low PNI (<41) and high AFP were independent predictors of early mortality for non-ruptured HCC. In 51 patients who had none of these three factors, only four (7.8%) patients experienced early mortality from disease recurrence.
  
  
  CONCLUSIONS
  Spontaneous rupture, high AFP, and low PNI were predictors of early mortality from disease recurrence after LR for huge HCC. J. Surg. Oncol. 2016;113:621-627. © 2016 Wiley Periodicals, Inc.
authors: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.|Duke-NUS Graduate Medical School, Singapore.
authors: Brian K P
authors: BK
authors: Goh
authors: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.
authors: Juinn Huar
authors: JH
authors: Kam
authors: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.
authors: Ser-Yee
authors: SY
authors: Lee
authors: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.
authors: Chung-Yip
authors: CY
authors: Chan
authors: Duke-NUS Graduate Medical School, Singapore.
authors: John C
authors: JC
authors: Allen
authors: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.
authors: Premaraj
authors: P
authors: Jeyaraj
authors: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.
authors: Peng-Chung
authors: PC
authors: Cheow
authors: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.|Duke-NUS Graduate Medical School, Singapore.
authors: Pierce K H
authors: PK
authors: Chow
authors: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.|Duke-NUS Graduate Medical School, Singapore.
authors: London L P J
authors: LL
authors: Ooi
authors: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.
authors: Alexander Y F
authors: AY
authors: Chung
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D001792:Blood Platelets / Q000378:metabolism*; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007958:Leukocyte Count; D008113:Liver Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008214:Lymphocytes / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000209:etiology / Q000401:mortality; D009504:Neutrophils / Q000378:metabolism*; D015596:Nutrition Assessment; D009752:Nutritional Status; D010976:Platelet Count; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D015415:Biomarkers
keywords: hepatocellular carcinoma; huge; neutrophil-to-lymphocyte ratio; platelet-to-lymphocyte ratio; prognostic nutrition index