Preoperative Neutrophil‐to‐Lymphocyte Ratio as a Prognostic Predictor after Curative Resection for Hepatocellular Carcinoma

Abstract

Background: This study was designed to evaluate the impact of an elevated preoperative neutrophil‐to‐lymphocyte ratio (NLR) on outcome after curative resection for hepatocellular carcinoma (HCC). Methods: Patients undergoing resection for HCC from January 1994 to May 2007 were identified from the hepatobiliary database. Demographics, laboratory analyses, and histopathology data were analyzed. Results: A total of 96 patients were identified with a median age at diagnosis of 65 (range, 15–85) years. The 1‐, 3‐, and 5‐year overall survival rates were 80%, 58%, and 52%, respectively. Although the presence of microvascular invasion, NLR ≥5, and R1 resection margin were adverse predictors of overall survival, there were no independent predictors identified on multivariate analysis. The 1‐, 3‐, and 5‐year disease‐free survival rates were 74%, 63%, and 57%, respectively. Preoperative tumor biopsy, NLR ≥ 5, multiple liver tumors, microvascular invasion, and R1 resection margin were all predictors of poorer disease‐free survival. Multivariate analysis showed that a NLR ≥ 5 and R1 resection margin were independent predictors of poorer disease‐free survival. The median disease‐free survival of those with a NLR ≥ 5 was 8 months compared with 18 months for those with a NLR < 5. Conclusion: Preoperative NLR ≥ 5 was an adverse predictor of disease‐free and overall survival.