title: Blood Neutrophil-to-Lymphocyte Ratio Predicts Tumor Recurrence in Patients with Hepatocellular Carcinoma within Milan Criteria after Hepatectomy.
abstract: OBJECTIVE
  The systemic inflammation biomarker, Neutrophil-to-Lymphocyte Ratio (NLR), has been reported as one of the adverse prognostic factors for hepatocellular carcinoma (HCC) patient. The purpose of this study was to evaluate whether NLR could predict the risk of recurrence and death for the HCC patient, according to Milan criteria after hepatectomy.
  
  
  METHODS
  Retrospective analysis was performed on a database of HCC patients who underwent hepatectomy between March 2001 and December 2011. The cutoff value of NLR was decided by receiver operating characteristic (ROC) curve analysis. Univariate and multivariate regression analyses were performed to identify predictive factors of recurrence and death.
  
  
  RESULTS
  A total of 213 patients were included in the present study. The median follow-up period was 48 months. One hundred and seven patients were experienced tumor recurrence; forty of them recurred within 12 months (early recurrence). NLR ≥1.505, albumin ≤3.75 g/dL, microvascular invasion and high grade of cirrhosis were found to be independent factors for adverse recurrence-free survival in multivariate regression analysis. And NLR ≥1.945 was also found as a prognosis factor for early recurrence by univariate regression analysis.
  
  
  CONCLUSIONS
  Elevated preoperative NLR can be easily obtained and reliable biomarker for assessing the tumor recurrence and early recurrence of Milan criteria HCC after the initial hepatectomy.
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Xu Guang
authors.initials: XG
authors.lastname: Hu
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Wei
authors.initials: W
authors.lastname: Mao
authors.affiliation: Department of Surgery, International St. Mary's Hospital, Incheon, Korea.
authors.forename: Yong Keun
authors.initials: YK
authors.lastname: Park
authors.affiliation: Department of Surgery, Yanji City Hospital, Jilin, China.
authors.forename: Wei Guang
authors.initials: WG
authors.lastname: Xu
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Bong Wan
authors.initials: BW
authors.lastname: Kim
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Ajou University School of Medicine, Suwon, Korea. wanghj@ajou.ac.kr.
authors.forename: Hee Jung
authors.initials: HJ
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers; D014408:Biomarkers, Tumor / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D018655:Lymphocyte Count; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood*; D009504:Neutrophils; D012372:ROC Curve; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D014408:Biomarkers, Tumor
keywords: Neutrophils; hepatectomy; hepatocellular carcinoma; lymphocytes; prognosis