title: Prognostic value of combined preoperative fibrinogen and neutrophil-lymphocyte ratio in patients with hepatocellular carcinoma after liver transplantation.
abstract: OBJECTIVE
  Elevated plasma fibrinogen (Fib) correlated with patient's prognosis in several solid tumors. However, few studies have illuminated the relationship between preoperative Fib and prognosis of HCC after liver transplantation. We aimed to clarify the prognostic value of Fib and whether the prognostic accuracy can be enhanced by the combination of Fib and neutrophil-lymphocyte ratio (NLR).
  
  
  RESULTS
  Fib was correlated with Child-pugh stage, alpha-fetoprotein (AFP), size of largest tumor, macro- and micro-vascular invasion. Univariate analysis showed preoperative Fib, AFP, NLR, size of largest tumor, tumor number, macro- and micro- vascular invasion were significantly associated with disease-free survival (DFS) and overall survival (OS) in HCC patients with liver transplantation. After multivariate analysis, only Fib and macro-vascular invasion were independently correlated with DFS and OS. Survival analysis showed that preoperative Fib > 2.345 g/L predicted poor prognosis of patients HCC after liver transplantation. Preoperative Fib showed prognostic value in various subgroups of HCC. Furthermore, the predictive range was expanded by the combination of Fib and NLR.
  
  
  METHODS
  Data were collected retrospectively from 130 HCC patients who underwent liver transplantation. Preoperative Fib, NLR and clinicopathologic variables were analyzed. The survival analysis was performed by the Kaplan-Meier method, and compared by the log-rank test. Univariate and multivariate analyses were performed to identify the prognostic factors for DFS and OS.
  
  
  CONCLUSIONS
  Preoperative Fib is an independent effective predictor of prognosis for HCC patients, higher levels of Fib predict poorer outcomes and the combination of Fib and NLR enlarges the prognostic accuracy of testing.
authors.affiliation: Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.|Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.|Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.|Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510120, China.
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, P. R. China.|Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.|Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.
authors.forename: Fei
authors.initials: F
authors.lastname: Ji
authors.affiliation: Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.|Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.|Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.
authors.forename: Ming
authors.initials: M
authors.lastname: Han
authors.affiliation: Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.|Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.|Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.
authors.forename: Mao-Gen
authors.initials: MG
authors.lastname: Chen
authors.affiliation: Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.|Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.|Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.
authors.forename: Xiao-Ping
authors.initials: XP
authors.lastname: Wang
authors.affiliation: Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.|Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.|Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.
authors.forename: Wei-Qiang
authors.initials: WQ
authors.lastname: Ju
authors.affiliation: Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.|Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.|Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Zhao
authors.affiliation: Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.|Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.|Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.
authors.forename: Lin-Wei
authors.initials: LW
authors.lastname: Wu
authors.affiliation: Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.|Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.|Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.
authors.forename: Qing-Qi
authors.initials: QQ
authors.lastname: Ren
authors.affiliation: Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.|Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.|Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.
authors.forename: Zhi-Yong
authors.initials: ZY
authors.lastname: Guo
authors.affiliation: Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.|Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.|Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.
authors.forename: Dong-Ping
authors.initials: DP
authors.lastname: Wang
authors.affiliation: Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.|Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.|Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.
authors.forename: Xiao-Feng
authors.initials: XF
authors.lastname: Zhu
authors.affiliation: Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.|Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.|Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.|Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.|Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.
authors.forename: Xiao-Shun
authors.initials: XS
authors.lastname: He
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000166:cytology*; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D047368:Tumor Burden; D055815:Young Adult; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000509:alpha-Fetoproteins; D005340:Fibrinogen
keywords: fibrinogen; hepatocellular carcinoma; liver transplantation; neutrophil–lymphocyte ration; prognosis