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Combined Hangzhou criteria with neutrophil-lymphocyte ratio is superior to other criteria in selecting liver transplantation candidates with HBV-related hepatocellular carcinoma.
- Source :
-
Hepatobiliary & pancreatic diseases international : HBPD INT [Hepatobiliary Pancreat Dis Int] 2015 Dec; Vol. 14 (6), pp. 588-95. - Publication Year :
- 2015
-
Abstract
- Background: The elevation of neutrophil-lymphocyte ratio (NLR) has adverse effects on the prognosis of patients with hepatocellular carcinoma (HCC) who have received liver transplantation (LT). The Hangzhou criteria are set for selecting HCC patients for LT. The present study aimed to establish a set of new criteria combining the NLR and Hangzhou criteria for selecting HCC patients for LT.<br />Methods: Receiver operating characteristic (ROC) analysis was done to determine the optimal NLR threshold. Univariate and multivariate analyses were made to evaluate the factors affecting the outcomes of HCC patients after LT. We also proposed new criteria consisting of the elevated NLR and Hangzhou criteria. ROC analysis was carried out to validate the feasibility of the new criteria.<br />Results: Three hundred and five HCC patients were included in this study. The mean follow-up time of these patients was 5.4 years. Of the 305 patients, 197 (64.6%) showed elevated NLRs (NLR > 4). The recurrence-free survival rates of the patients with elevated NLRs at 1, 3 and 5 years were lower than those of the patients with normal NLRs (NLR ≤ 4) (50.1%, 21.7% and 20.2% vs 80.5%, 58.7% and 56.4%, respectively; P < 0.001). The overall survival rate was lower in the patients with elevated NLR than in those with normal NLR at 1, 3 and 5 years (60.8%, 27.0% and 22.5% vs 78.4%, 51.1% and 47.8%, respectively; P < 0.001). Multivariate analysis demonstrated that an NLR > 4 (P = 0.034), total tumor size > 8 cm (P = 0.005), alpha-fetoprotein level > 400 μg/L (P = 0.007) and the presence of vascular invasion (P = 0.003) were independent predictors of HCC recurrence in post-transplant patients. We proposed a set of new criteria based on the elevated NLR and Hangzhou criteria. A ROC analysis demonstrated that the patients with scores ≥ 1 had an area under the curve of 0.764.<br />Conclusion: The criteria combining the elevated NLR and Hangzhou criteria can be used to select patients with HCC for LT.
- Subjects :
- Area Under Curve
Carcinoma, Hepatocellular blood
Carcinoma, Hepatocellular diagnosis
Carcinoma, Hepatocellular mortality
Carcinoma, Hepatocellular virology
Chi-Square Distribution
Disease Progression
Disease-Free Survival
Feasibility Studies
Female
Hepatitis B diagnosis
Hepatitis B mortality
Humans
Kaplan-Meier Estimate
Liver Neoplasms blood
Liver Neoplasms diagnosis
Liver Neoplasms mortality
Liver Neoplasms virology
Lymphocyte Count
Male
Middle Aged
Multivariate Analysis
Neoplasm Invasiveness
Neoplasm Recurrence, Local
Predictive Value of Tests
Proportional Hazards Models
ROC Curve
Registries
Reproducibility of Results
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Tumor Burden
alpha-Fetoproteins analysis
Carcinoma, Hepatocellular surgery
Decision Support Techniques
Hepatitis B complications
Liver Neoplasms surgery
Liver Transplantation adverse effects
Liver Transplantation mortality
Lymphocytes
Neutrophils
Patient Selection
Subjects
Details
- Language :
- English
- ISSN :
- 1499-3872
- Volume :
- 14
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Hepatobiliary & pancreatic diseases international : HBPD INT
- Publication Type :
- Academic Journal
- Accession number :
- 26663006
- Full Text :
- https://doi.org/10.1016/s1499-3872(15)60416-7