Skip to main content
SpringerLink
Log in

Preoperative neutrophil-to-lymphocyte ratio as a predictor of survival after reductive surgery plus percutaneous isolated hepatic perfusion for hepatocellular carcinoma: a retrospective analysis

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

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].

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma. Lancet. 2012;379:1245–55.

    Article  PubMed  Google Scholar 

  2. Pang TC, Lam VW. Surgical management of hepatocellular carcinoma. World J Hepatol. 2015;7:245–52.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kawaguchi Y, Otsuka Y, Kaneko H, Nagai M, Nomura Y, Yamamoto M, et al. Comparisons of financial and short-term outcomes between laparoscopic and open hepatectomy: benefits for patients and hospitals. Surg Today. 2016;46:535–42.

    Article  PubMed  Google Scholar 

  4. Harimoto N, Shirabe K, Nakagawara H, Toshima T, Yamashita Y, Ikegami T, et al. Prognostic factors affecting survival at recurrence of hepatocellular carcinoma after living-donor liver transplantation: with special reference to neutrophil/lymphocyte ratio. Transplantation. 2013;96:1008–12.

    Article  CAS  PubMed  Google Scholar 

  5. Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008;359:378–90.

    Article  CAS  PubMed  Google Scholar 

  6. Cheng AL, Kang YK, Chen Z, Tsao CJ, Qin S, Kim JS, et al. Efficacy and safety of sorafenib in patients in the Asia–Pacific region with advanced hepatocellular carcinoma: a phase iii randomised, double-blind, placebo-controlled trial. Lancet Oncol. 2009;10:25–34.

    Article  CAS  PubMed  Google Scholar 

  7. Ku Y, Iwasaki T, Fukumoto T, Tominaga M, Muramatsu S, Kusunoki N, et al. Induction of long-term remission in advanced hepatocellular carcinoma with percutaneous isolated liver chemoperfusion. Ann Surg. 1998;227:519–26.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Ku Y, Iwasaki T, Tominaga M, Fukumoto T, Takahashi T, Kido M, et al. Reductive surgery plus percutaneous isolated hepatic perfusion for multiple advanced hepatocellular carcinoma. Ann Surg. 2004;239:53–60.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Fukumoto T, Tominaga M, Kido M, Takebe A, Tanaka M, Kuramitsu K, et al. Long-term outcomes and prognostic factors with reductive hepatectomy and sequential percutaneous isolated hepatic perfusion for multiple bilobar hepatocellular carcinoma. Ann Surg Oncol. 2014;21:971–8.

    Article  PubMed  Google Scholar 

  10. Liao W, Zhang J, Zhu Q, Qin L, Yao W, Lei B, et al. Preoperative neutrophil-to-lymphocyte ratio as a new prognostic marker in hepatocellular carcinoma after curative resection. Transl Oncol. 2014;7:248–55.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Fu SJ, Shen SL, Li SQ, Hua YP, Hu WJ, Liang LJ, et al. Prognostic value of preoperative peripheral neutrophil-to-lymphocyte ratio in patients with Hbv-associated hepatocellular carcinoma after radical hepatectomy. Med Oncol. 2013;30:721.

    Article  PubMed  Google Scholar 

  12. Mano Y, Shirabe K, Yamashita Y, Harimoto N, Tsujita E, Takeishi K, et al. Preoperative neutrophil-to-lymphocyte ratio is a predictor of survival after hepatectomy for hepatocellular carcinoma: a retrospective analysis. Ann Surg. 2013;258:301–5.

    Article  PubMed  Google Scholar 

  13. Terashima T, Yamashita T, Iida N, Yamashita T, Nakagawa H, Arai K, et al. Blood neutrophil to lymphocyte ratio as a predictor in patients with advanced hepatocellular carcinoma treated with hepatic arterial infusion chemotherapy. Hepatol Res. 2014;45:949–59.

    Article  Google Scholar 

  14. Chen TM, Lin CC, Huang PT, Wen CF. Neutrophil-to-lymphocyte ratio associated with mortality in early hepatocellular carcinoma patients after radiofrequency ablation. J Gastroenterol Hepatol. 2012;27:553–61.

    Article  CAS  PubMed  Google Scholar 

  15. Peng W, Li C, Wen TF, Yan LN, Li B, Wang WT, et al. Neutrophil to lymphocyte ratio changes predict small hepatocellular carcinoma survival. J Surg Res. 2014;192:402–8.

    Article  PubMed  Google Scholar 

  16. Xue TC, Zhang L, Xie XY, Ge NL, Li LX, Zhang BH, et al. Prognostic significance of the neutrophil-to-lymphocyte ratio in primary liver cancer: a meta-analysis. PLoS One. 2014;9:e96072.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Li C, Wen TF, Yan LN, Li B, Wang WT, Yang JY, et al. Postoperative neutrophil-to-lymphocyte ratio plus platelet-to-lymphocyte ratio predicts the outcomes of hepatocellular carcinoma. J Surg Res. 2015;198:73–9.

    Article  PubMed  Google Scholar 

  18. Kudo M, Kitano M, Sakurai T, Nishida N. General rules for the clinical and pathological study of primary liver cancer, nationwide follow-up survey and clinical practice guidelines: the outstanding achievements of the Liver Cancer Study Group of Japan. Dig Dis. 2015;33:765–70.

    Article  PubMed  Google Scholar 

  19. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Katayama H, Kurokawa Y, Nakamura K, Ito H, Kanemitsu Y, Masuda N, et al. Extended Clavien-Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today. 2016;46:668–85.

    Article  PubMed  Google Scholar 

  21. Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92:205–16.

    Article  CAS  PubMed  Google Scholar 

  22. Villa E, Moles A, Ferretti I, Buttafoco P, Grottola A, Del Buono M, et al. Natural history of inoperable hepatocellular carcinoma: estrogen receptors’ status in the tumor is the strongest prognostic factor for survival. Hepatology. 2000;32:233–8.

    Article  CAS  PubMed  Google Scholar 

  23. Llovet JM, Bustamante J, Castells A, Vilana R, Ayuso Mdel C, Sala M, et al. Natural history of untreated nonsurgical hepatocellular carcinoma: rationale for the design and evaluation of therapeutic trials. Hepatology. 1999;29:62–7.

    Article  CAS  PubMed  Google Scholar 

  24. Quirk M, Kim YH, Saab S, Lee EW. Management of hepatocellular carcinoma with portal vein thrombosis. World J Gastroenterol. 2015;21:3462–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Ikai I, Yamaoka Y, Yamamoto Y, Ozaki N, Sakai Y, Satoh S, et al. Surgical intervention for patients with stage iv-a hepatocellular carcinoma without lymph node metastasis: proposal as a standard therapy. Ann Surg. 1998;227:433–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Shimada M, Takenaka K, Kawahara N, Kajiyama K, Yamamoto K, Shirabe K, et al. Surgical treatment strategy for patients with stage iv hepatocellular carcinoma. Surgery. 1996;119:517–22.

    Article  CAS  PubMed  Google Scholar 

  27. Maltoni M, Caraceni A, Brunelli C, Broeckaert B, Christakis N, Eychmueller S, et al. Prognostic factors in advanced cancer patients: evidence-based clinical recommendations—a study by the Steering Committee of the European Association for palliative care. J Clin Oncol. 2005;23:6240–8.

    Article  PubMed  Google Scholar 

  28. McMillan DC. An inflammation-based prognostic score and its role in the nutrition-based management of patients with cancer. Proc Nutr Soc. 2008;67:257–62.

    Article  PubMed  Google Scholar 

  29. Asari S, Matsumoto I, Toyama H, Shinzeki M, Goto T, Ishida J, et al. Preoperative independent prognostic factors in patients with borderline resectable pancreatic ductal adenocarcinoma following curative resection: the neutrophil-lymphocyte and platelet-lymphocyte ratios. Surg Today. 2016;46:583–92.

    Article  PubMed  Google Scholar 

  30. Shirabe K, Mano Y, Muto J, Matono R, Motomura T, Toshima T, et al. Role of tumor-associated macrophages in the progression of hepatocellular carcinoma. Surg Today. 2012;42:1–7.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Takashi Omori at Center for Clinical Research at Kobe University Hospital (Kobe City, Japan) for his advice regarding the statistical analysis.

Author information

Authors and Affiliations

  1. 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

    Keisuke Arai, Takumi Fukumoto, Masahiro Kido, Motofumi Tanaka, Kaori Kuramitsu, Hisoka Kinoshita, Shohei Komatsu, Daisuke Tsugawa, Sachio Terai, Taku Matsumoto, Tadahiro Goto, Sadaki Asari, Hirochika Toyama, Tetsuo Ajiki & Yonson Ku

Authors
  1. Keisuke Arai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takumi Fukumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masahiro Kido
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Motofumi Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kaori Kuramitsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hisoka Kinoshita
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shohei Komatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Daisuke Tsugawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Sachio Terai
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Taku Matsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Tadahiro Goto
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Sadaki Asari
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Hirochika Toyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Tetsuo Ajiki
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Yonson Ku
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Keisuke Arai.

Ethics declarations

Conflict of interest

We have no financial conflicts of interest to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Arai, K., Fukumoto, T., Kido, M. et al. Preoperative neutrophil-to-lymphocyte ratio as a predictor of survival after reductive surgery plus percutaneous isolated hepatic perfusion for hepatocellular carcinoma: a retrospective analysis. Surg Today 47, 385–392 (2017). https://doi.org/10.1007/s00595-016-1384-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-016-1384-7

Keywords

Search

Navigation