title: A novel and accurate predictor of survival for patients with hepatocellular carcinoma after surgical resection: the neutrophil to lymphocyte ratio (NLR) combined with the aspartate aminotransferase/platelet count ratio index (APRI).
abstract: BACKGROUND
  The occurrence and development of hepatocellular carcinoma (HCC) depends largely on such non-tumor factors as inflammatory condition, immune state, viral infection and liver fibrosis. Various inflammation-based prognostic scores have been associated with survival in patients with HCC, such as the neutrophil/lymphocyte ratio (NLR), the platelet/lymphocyte ratio (PLR) and the prognostic nutritional index (PNI). The aspartate aminotransferase/platelet count ratio index (APRI) is thought to be a biomarker of liver fibrosis and cirrhosis. This study aims to evaluate the ability of these indices to predict survival in HCC patients after curative hepatectomy, and probe the increased prognostic accuracy of APRI combined with established inflammation-based prognostic scores.
  
  
  METHODS
  Data were collected retrospectively from 321 patients who underwent curative resection for HCC. Preoperative NLR, PLR, PNI, APRI and clinico-pathological variables were analyzed. Univariate and multivariate analyses were performed to identify the predictive value of the above factors for disease-free survival (DFS) and overall survival (OS).
  
  
  RESULTS
  Univariate analysis showed that NLR, PLR, PNI and APRI were significantly associated with DFS and OS in HCC patients with curative resection. Multivariate analysis showed that NLR and APRI were superior to PLR and PNI, and both were independently correlated with DFS and OS. Preoperative NLR >2 or APRI >1.68 predicted poor prognosis of patients with HCC after hepatectomy. Furthermore, the predictive range of NLR combined with APRI was more sensitive than that of either measure alone.
  
  
  CONCLUSIONS
  Preoperative NLR and APRI are independent predictors of DFS and OS in patients with HCC after surgical resection. Higher levels of NLR or APRI predict poorer outcomes in HCC patients. Intriguingly, combining NLR and APRI increases the prognostic accuracy of testing.
authors.affiliation: Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, PR China. jifei1215@163.com.
authors.forename: Fei
authors.initials: F
authors.lastname: Ji
authors.affiliation: Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, 510060, PR China. liangyao@sysucc.org.cn.
authors.forename: Yao
authors.initials: Y
authors.lastname: Liang
authors.affiliation: Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, PR China. fsj103@163.com.
authors.forename: Shun-Jun
authors.initials: SJ
authors.lastname: Fu
authors.affiliation: Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, PR China. rockyucsf1981@126.com.
authors.forename: Zhi-Yong
authors.initials: ZY
authors.lastname: Guo
authors.affiliation: Department of Pathology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, PR China. amanda1213xxfz@126.com.
authors.forename: Man
authors.initials: M
authors.lastname: Shu
authors.affiliation: Department of Liver Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, PR China. shunlishen@163.com.
authors.forename: Shun-Li
authors.initials: SL
authors.lastname: Shen
authors.affiliation: Department of Liver Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, PR China. Lisq@medmail.com.cn.
authors.forename: Shao-Qiang
authors.initials: SQ
authors.lastname: Li
authors.affiliation: Department of Liver Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, PR China. pengbaogang@medmail.com.cn.
authors.forename: Bao-Gang
authors.initials: BG
authors.lastname: Peng
authors.affiliation: Department of Liver Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, PR China. dr_lianglj@163.com.
authors.forename: Li-Jian
authors.initials: LJ
authors.lastname: Liang
authors.affiliation: Department of Liver Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, PR China. hyp0427@163.com.
authors.forename: Yun-Peng
authors.initials: YP
authors.lastname: Hua
mesh_terms: D000328:Adult; D000368:Aged; D001219:Aspartate Aminotransferases / Q000378:metabolism*; D006528:Carcinoma, Hepatocellular / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D008214:Lymphocytes / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000276:immunology*; D015596:Nutrition Assessment; D010976:Platelet Count; D011379:Prognosis; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D001219:Aspartate Aminotransferases