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Significance of neutrophil‐to‐lymphocyte ratio, platelet‐to‐lymphocyte ratio and prognostic nutrition index as preoperative predictors of early mortality after liver resection for huge (≥10 cm) hepatocellular carcinoma
Author(s) -
Goh Brian K.P.,
Kam Juinn Huar,
Lee SerYee,
Chan ChungYip,
Allen John C.,
Jeyaraj Premaraj,
Cheow PengChung,
Chow Pierce K.H.,
Ooi London L.P.J.,
Chung Alexander Y.F.
Publication year - 2016
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24197
Subject(s) - medicine , youden's j statistic , hepatocellular carcinoma , gastroenterology , lymphocyte , multivariate analysis , receiver operating characteristic , neutrophil to lymphocyte ratio , mortality rate , surgery
Background This study aimed to determine preoperative predictors of early (<1 year) mortality from disease recurrence after liver resection (LR) for huge (≥10 cm) HCC, with special emphasis on the importance of neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), and prognostic nutrition index (PNI). Methods Between 2000 to 2013, 166 patients underwent LR for huge HCC. Optimal cut‐offs for alpha fetoprotein (AFP), NLR, PLR, and PNI were determined by plotting the receiver operator curves (ROC) in predicting early mortality and utilizing the Youden index. Results The 30‐day/in‐hospital postoperative mortality rate was 4.2%. The 5‐year overall survival (OS) and the 5‐year recurrence‐free survival (RFS) was 43% and 24%, respectively. Early mortality from disease recurrence occurred in 35 of 159 (22%) patients. Multivariate analyses demonstrated that tumor rupture and high AFP (>1,085 ng/ml) were independent preoperative predictors of early mortality after LR for HCC, and both a low PNI (<41) and high AFP were independent predictors of early mortality for non‐ruptured HCC. In 51 patients who had none of these three factors, only four (7.8%) patients experienced early mortality from disease recurrence. Conclusions Spontaneous rupture, high AFP, and low PNI were predictors of early mortality from disease recurrence after LR for huge HCC. J. Surg. Oncol. 2016;113:621–627 . © 2016 Wiley Periodicals, Inc.