title: Prognostic value of fever grade combined with neutrophil percentage in hepatocellular carcinoma patients presenting fever as the initial manifestation.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) patients with fever as the initial presentation are extremely rare. Our aim was to investigate the clinical characteristics and prognosis of patients with this disease.
  
  
  METHODS
  The clinical features were analyzed in a retrospective study of 63 HCC patients with fever as the first manifestation and 300 HCC patients without fever as the control group.
  
  
  RESULTS
  HCC patients with fever had a higher neutrophil percentage, larger tumor size, worse tumor differentiation, advanced Barcelona Clinic Liver Cancer stage, and more hilar lymph node metastasis than HCC patients without fever (allP<0.05). Compared with HCC patients without fever, patients presenting with fever had shorter overall survival (OS, median: 13 months,P<0.001) and time to recurrence (TTR, median: 7.5 months,P<0.001). In addition, HCC patients with fever also had shorter OS and TTR than those without fever in all clinical subgroups with aggressive features (allP<0.05). Multivariate analysis showed that neutrophil percentage >70%, fever grade ≥38.5°C, tumor size >5 cm, and hilar lymph node metastasis were independent factors for OS and TTR. A positive correlation was observed between body temperature and serum neutrophil percentage (r=0.527,P<0.001). Patients with a fever grade ≥38.5°C had more incomplete encapsulation and larger tumor size, while those with a neutrophil percentage >70% presented with more incomplete encapsulation, vascular invasion, and worse tumor differentiation. Patients with a fever grade ≥38.5°C combined with a neutrophil percentage >70% had worse OS and TTR than other groups.
  
  
  CONCLUSIONS
  HCC patients presenting with fever have poorer prognosis than those without fever; however, their prognosis could be improved by timely surgical intervention. Patients with a neutrophil percentage >70% and a fever grade ≥38.5°C represent a rare HCC subgroup with an extremely dismal outcome and more aggressive clinical course.
authors: Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China; Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, People's Republic of China.
authors: Zi-Jun
authors: ZJ
authors: Gong
authors: Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China; Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, People's Republic of China; Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
authors: Wei
authors: W
authors: Guo
authors: Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China; Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, People's Republic of China.
authors: Yun-Fan
authors: YF
authors: Sun
authors: Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China; Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, People's Republic of China.
authors: Xin
authors: X
authors: Zhang
authors: Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China; Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, People's Republic of China.
authors: Shuang-Jian
authors: SJ
authors: Qiu
authors: Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China; Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, People's Republic of China; Institutes of Biomedical Sciences, Fudan University, Shanghai, People's Republic of China.
authors: Jian
authors: J
authors: Zhou
authors: Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China; Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, People's Republic of China; Institutes of Biomedical Sciences, Fudan University, Shanghai, People's Republic of China.
authors: Jia
authors: J
authors: Fan
authors: Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China; Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, People's Republic of China.
authors: Xin-Rong
authors: XR
authors: Yang
keywords: fever; hepatectomy; hepatocellular carcinoma; neutrophils; prognosis