title: Preoperative neutrophil-to-lymphocyte ratio as a predictor of survival after reductive surgery plus percutaneous isolated hepatic perfusion for hepatocellular carcinoma: a retrospective analysis.
abstract: OBJECTIVE
  We assessed the predictive value of the preoperative neutrophil-to-lymphocyte ratio (NLR) in patients who underwent a two-stage treatment combining reductive surgery and percutaneous isolated hepatic perfusion for multiple hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT).
  
  
  METHODS
  Forty-two patients underwent the two-stage treatment between January 2000 and December 2014 at Kobe University Hospital (Hyogo, Japan). The NLR was calculated from lymphocyte and neutrophil counts in the preoperative routine blood test. Clinical data and overall survival were compared statistically and multivariate analysis was done to identify prognostic factors.
  
  
  RESULTS
  The median survival of patients with a preoperative NLR > 2.3 was 14.9 months (n = 13), whereas that of patients with a preoperative NLR ≤ 2.3 was 26.1 months (n = 29; P = 0.022). A preoperative NLR > 2.3 was an independent prognostic factor in patients with multiple HCC with PVTT [hazard ratio (HR) 2.329; 95 % confidence interval (CI) 1.058-5.667; P = 0.036].
  
  
  CONCLUSIONS
  Based on the results of this study, an elevated preoperative NLR is an independent predictive risk factor for patients undergoing two-stage treatment for multiple HCC with PVTT.
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe City, Hyogo, 650-0017, Japan. karai51@outlook.jp.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Arai
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe City, Hyogo, 650-0017, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Fukumoto
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe City, Hyogo, 650-0017, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kido
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe City, Hyogo, 650-0017, Japan.
authors.forename: Motofumi
authors.initials: M
authors.lastname: Tanaka
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe City, Hyogo, 650-0017, Japan.
authors.forename: Kaori
authors.initials: K
authors.lastname: Kuramitsu
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe City, Hyogo, 650-0017, Japan.
authors.forename: Hisoka
authors.initials: H
authors.lastname: Kinoshita
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe City, Hyogo, 650-0017, Japan.
authors.forename: Shohei
authors.initials: S
authors.lastname: Komatsu
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe City, Hyogo, 650-0017, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Tsugawa
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe City, Hyogo, 650-0017, Japan.
authors.forename: Sachio
authors.initials: S
authors.lastname: Terai
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe City, Hyogo, 650-0017, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Matsumoto
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe City, Hyogo, 650-0017, Japan.
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Goto
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe City, Hyogo, 650-0017, Japan.
authors.forename: Sadaki
authors.initials: S
authors.lastname: Asari
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe City, Hyogo, 650-0017, Japan.
authors.forename: Hirochika
authors.initials: H
authors.lastname: Toyama
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe City, Hyogo, 650-0017, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ajiki
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe City, Hyogo, 650-0017, Japan.
authors.forename: Yonson
authors.initials: Y
authors.lastname: Ku
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000401:mortality* / Q000628:therapy*; D003131:Combined Modality Therapy / Q000401:mortality; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D007958:Leukocyte Count; D008113:Liver Neoplasms / Q000097:blood / Q000401:mortality* / Q000628:therapy*; D018655:Lymphocyte Count; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009504:Neutrophils; D010477:Perfusion / Q000379:methods*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
keywords: Hepatocellular carcinoma; Invasion to the portal vein; Neutrophil-to-lymphocyte ratio