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Gao TM, Xiao KQ, Xiang XX, Jin SJ, Qian JJ, Zhang C, Zhou BH, Tang H, Bai DS, Jiang GQ. The decreased risk of hepatocellular carcinoma in hepatitis B virus-related cirrhotic portal hypertension patients after laparoscopic splenectomy and azygoportal disconnection. Surg Endosc 2023; 37:8522-8531. [PMID: 37775601 DOI: 10.1007/s00464-023-10454-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/06/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Posthepatitic cirrhosis is one of the leading risk factors for hepatocellular carcinoma (HCC) worldwide, among which hepatitis B cirrhosis is the dominant one. This study explored whether laparoscopic splenectomy and azygoportal disconnection (LSD) can reduce the risk of HCC among patients with hepatitis B virus (HBV)-related cirrhotic portal hypertension (CPH). METHODS A total of 383 patients with HBV-related CPH diagnosed as gastroesophageal variceal bleeding and secondary hypersplenism were identified in our hepatobiliary pancreatic center between April 2012 and April 2022, and conducted an 11-year retrospective follow-up. We used inverse probability of treatment weighting (IPTW) to correct for potential confounders, weighted Kaplan-Meier curves, and logistic regression to estimate survival and risk differences. RESULTS Patients were divided into two groups based on treatment method: LSD (n = 230) and endoscopic therapy (ET; n = 153) groups. Whether it was processed through IPTW or not, LSD group showed a higher survival benefit than ET group according to Kaplan-Meier analysis (P < 0.001). The incidence density of HCC was higher in the ET group compared to LSD group at the end of follow-up [32.1/1000 vs 8.0/1000 person-years; Rate ratio: 3.998, 95% confidence intervals (CI) 1.928-8.293]. Additionally, in logistic regression analyses weighted by IPTW, LSD was an independent protective predictor of HCC incidence compared to ET (odds ratio 0.516, 95% CI 0.343-0.776; P = 0.002). CONCLUSION Considering the ability of LSD to improve postoperative survival and prevent HCC in HBV-related CPH patients with gastroesophageal variceal bleeding and secondary hypersplenism, it is worth promoting in the context of the shortage of liver donors.
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Affiliation(s)
- Tian-Ming Gao
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, 98 West Nantong Rd, Yangzhou, 225001, China
| | - Kun-Qing Xiao
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, 98 West Nantong Rd, Yangzhou, 225001, China
| | - Xiao-Xing Xiang
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, 98 West Nantong Rd, Yangzhou, 225001, China
- Department of Digestive Diseases, Clinical Medical College, Yangzhou University, 98 West Nantong Rd, Yangzhou, 225001, China
| | - Sheng-Jie Jin
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, 98 West Nantong Rd, Yangzhou, 225001, China
| | - Jian-Jun Qian
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, 98 West Nantong Rd, Yangzhou, 225001, China
| | - Chi Zhang
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, 98 West Nantong Rd, Yangzhou, 225001, China
| | - Bao-Huan Zhou
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, 98 West Nantong Rd, Yangzhou, 225001, China
| | - Hua Tang
- The Administration Office, Yangzhou Blood Center, Yangzhou, 225001, China
| | - Dou-Sheng Bai
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, 98 West Nantong Rd, Yangzhou, 225001, China.
| | - Guo-Qing Jiang
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, 98 West Nantong Rd, Yangzhou, 225001, China.
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Zhang W, Bi Y, Yang K, Xie Y, Li Z, Yu X, Zhang L, Jiang W. A new model based on gamma-glutamyl transpeptidase to lymphocyte ratio and systemic immune-inflammation index can effectively predict the recurrence of hepatocellular carcinoma after liver transplantation. Front Oncol 2023; 13:1178123. [PMID: 37152021 PMCID: PMC10157065 DOI: 10.3389/fonc.2023.1178123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/06/2023] [Indexed: 05/09/2023] Open
Abstract
Background Liver transplantation (LT) is one of the most effective treatment modalities for hepatocellular carcinoma (HCC), but patients with HCC recurrence after LT always have poor prognosis. This study aimed to evaluate the predictive value of the gamma-glutamyl transpeptidase-to-lymphocyte ratio (GLR) and systemic immune-inflammation index (SII) in terms of HCC recurrence after LT, based on which we developed a more effective predictive model. Methods The clinical data of 325 HCC patients who had undergone LT were collected and analyzed retrospectively. The patients were randomly divided into a development cohort (n = 215) and a validation cohort (n = 110). Cox regression analysis was used to screen the independent risk factors affecting postoperative recurrence in the development cohort, and a predictive model was established based on the results of the multivariate analysis. The predictive values of GLR, SII and the model were evaluated by receiver operating characteristic (ROC) curve analysis, which determined the cut-off value for indicating patients' risk levels. The Kaplan-Meier survival analysis and the competing-risk regression analysis were used to evaluate the predictive performance of the model, and the effectiveness of the model was verified further in the validation cohort. Results The recurrence-free survival of HCC patients after LT with high GLR and SII was significantly worse than that of patients with low GLR and SII (P<0.001). Multivariate Cox regression analysis identified GLR (HR:3.405; 95%CI:1.954-5.936; P<0.001), SII (HR: 2.285; 95%CI: 1.304-4.003; P=0.004), tumor number (HR:2.368; 95%CI:1.305-4.298; P=0.005), maximum tumor diameter (HR:1.906; 95%CI:1.121-3.242; P=0.017), alpha-fetoprotein level (HR:2.492; 95%CI:1.418-4.380; P=0.002) as independent risk factors for HCC recurrence after LT. The predictive model based on these risk factors had a good predictive performance in both the development and validation cohorts (area under the ROC curve=0.800, 0.791, respectively), and the performance of the new model was significantly better than that of single GLR and SII calculations (P<0.001). Survival analysis and competing-risk regression analysis showed that the predictive model could distinguish patients with varying levels of recurrence risk in both the development and validation cohorts. Conclusions The GLR and SII are effective indicators for evaluating HCC recurrence after LT. The predictive model based on these indicators can accurately predict HCC recurrence after LT and is expected to guide preoperative patient selection and postoperative follow-up.
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Affiliation(s)
- Weiqi Zhang
- School of Medicine, Nankai University, Tianjin, China
| | - Yi Bi
- Department of Liver Transplantation, Tianjin Medical University First Center Clinical College, Tianjin, China
| | - Kai Yang
- Department of Liver Transplantation, Tianjin Medical University First Center Clinical College, Tianjin, China
| | - Yan Xie
- Department of Liver Transplantation, Tianjin First Center Hospital, Tianjin, China
- Laboratory of Molecular and Treatment of Liver Cancer, Tianjin First Center Hospital, Tianjin, China
| | - Zhaoxian Li
- School of Medicine, Nankai University, Tianjin, China
| | - Xinghui Yu
- School of Medicine, Nankai University, Tianjin, China
| | - Li Zhang
- Department of Liver Transplantation, Tianjin First Center Hospital, Tianjin, China
- Laboratory of Molecular and Treatment of Liver Cancer, Tianjin First Center Hospital, Tianjin, China
| | - Wentao Jiang
- Department of Liver Transplantation, Tianjin First Center Hospital, Tianjin, China
- Laboratory of Molecular and Treatment of Liver Cancer, Tianjin First Center Hospital, Tianjin, China
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Hasan I, Lutfie L, Rinaldi I, Kurniawan J, Loho IM. Comparison Between Neutrophil-Lymphocyte Ratio and Systemic Immune-Inflammation Index as Predictors of One-Year Survival in Patients with Untreated Advanced Hepatocellular Carcinoma. J Gastrointest Cancer 2022; 54:135-146. [PMID: 35099753 DOI: 10.1007/s12029-021-00796-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Patients with hepatocellular carcinoma (HCC) generally only come for treatment when cancer has reached an advanced stage, with very limited treatment options. There has not been an accurate predictor marker to be able to identify which group of patients may have better survival. This study wanted to analyze the role of the inflammatory status indices as predictors of 1-year survival in patients with advanced HCC who did not undergo therapy. METHODS This study has a retrospective cohort design using secondary data on subjects with advanced HCC who did not undergo therapy at Cipto Mangunkusumo Hospital and Dharmais Hospital. The neutrophil-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) were evaluated for their role as predictors of 1-year survival based on the area under receiving operator curve (AUROC). The best optimal cut-off for NLR and SII was decided based on the Youden index, followed by survival analysis based on those cut-offs. Confounding factors were analyzed with multivariate cox regression analysis. RESULTS A total of 196 subjects were included in the data analysis. One-year survival was 6.6%, with a median survival of 56 days (95% CI: 46-67). The NLR had a discriminatory ability based on AUROC of 0.667 (95% CI: 0.536-0.798; p = 0.044), with the optimal cut-off point to differentiate survival was 3.7513. The SII has a discriminatory ability based on AUROC of 0.766 (95% CI: 0.643-0.889; p = 0.001), with the optimal cut-off point to distinguish survival was 954.4782. SII had superiority in discriminatory ability (p = 0.0415). CONCLUSIONS The discriminatory ability based on AUROC of SII was better than that of NLR in predicting 1-year survival in patients with advanced HCC who did not undergo therapy.
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Affiliation(s)
- Irsan Hasan
- Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/ Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Lutfie Lutfie
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia.
| | - Ikhwan Rinaldi
- Division of Medical Oncology Hematology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Juferdy Kurniawan
- Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/ Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Imelda Maria Loho
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Dharmais National Cancer Center Hospital, Jakarta, Indonesia
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Glasgow Prognostic Score and modified Glasgow Prognostic Score and survival in patients with hepatocellular carcinoma: a meta-analysis. BMJ Open 2021. [PMCID: PMC8718431 DOI: 10.1136/bmjopen-2021-053061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective To evaluate the association between inflammation-related markers, modified Glasgow Prognostic Score (mGPS) and Glasgow Prognostic Score (GPS), and survival outcome and recurrence risk in patients with hepatocellular carcinoma (HCC) after treatment. Design Systematic reviews and meta-analysis of cohort studies. Date sources Embase, Scopus, Web of Science and PubMed were searched through 10 March 2021. Eligibility criteria We included cohort studies that assessed the effect of pretreatment mGPS/GPS levels on survival outcomes in patients with HCC. Data extraction and synthesis Two researchers independently selected the data and reached a consensus. In case of disagreement, a third researcher was required to assist. The HRs and 95% CIs were used as the effect size indexes. Newcastle-Ottawa Scale was used to assess risk of bias and quality assessment of the included studies. Results The meta-analysis included 23 studies, most of which were retrospective. Participants were grouped according to the score of mGPS/GPS. When analysed into two groups (1/2 vs 0), the results showed that patients with a mGPS/GPS of 1 or 2 had poorer overall survival (OS) than those with a score of 0 (both p<0.001). When analysed into three groups (1 vs 0 and 2 vs 0), the results revealed that an mGPS/GPS of 2 is related to poorer OS in patients with HCC (HR=2.46, 95% CI 2.06 to 2.95, and HR=3.45, 95% CI 1.68 to 7.10, respectively). However, a GPS of 1 (p=0.005) but not an mGPS of 1 (p=0.177) had a significant association with OS. No association was found between mGPS/GPS and disease-free survival or recurrence-free survival. Conclusion GPS was more closely associated the survival in patients with HCC than mGPS. A higher GPS has an association with poorer survival. It can be combined with tumour staging to assess the OS of HCC more accurately. PROSPERO registration number CRD42021242049.
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Akkiz H, Carr BI, Bag HG, Karaoğullarından Ü, Yalçın K, Ekin N, Özakyol A, Altıntaş E, Balaban HY, Şimşek H, Uyanıkoğlu A, Balkan A, Kuran S, Üsküdar O, Ülger Y, Güney B, Delik A. Serum levels of inflammatory markers CRP, ESR and albumin in relation to survival for patients with hepatocellular carcinoma. Int J Clin Pract 2021; 75:e13593. [PMID: 32583494 PMCID: PMC7758189 DOI: 10.1111/ijcp.13593] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/18/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Hepatocellular carcinoma is associated with several chronic inflammatory conditions. It is increasingly understood that the inflammation may be part of the carcinogenic process and prognostically important. OBJECTIVE To evaluate the serum levels of three inflammation markers in relation to survival in HCC patients. METHODS We retrospectively examined the serum levels of CRP, albumin and ESR, both singly and in combination, in relation to patient survival. RESULTS Survival worsened with increase in CRP or ESR or decrease in albumin levels. Combinations of CRP plus albumin or CRP plus ESR were associated with an even greater range of survival (3-fold), together with significant differences in maximum tumor diameter (PVT) and percent of patients with portal vein thrombosis (PVT). The triplet of CRP plus albumin plus ESR was associated with a sevenfold difference in survival, comparing low vs high parameter levels. These significant differences were found in patients with small or large tumors. CONCLUSIONS Combinations of CRP with albumin or ESR or all three parameters together significantly related to differences in survival and to differences in MTD and percent PVT, in patients with both small and large size HCCs.
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Nakano M, Kuromatsu R, Niizeki T, Okamura S, Iwamoto H, Shimose S, Shirono T, Noda Y, Kamachi N, Koga H, Torimura T. Immunological inflammatory biomarkers as prognostic predictors for advanced hepatocellular carcinoma. ESMO Open 2021; 6:100020. [PMID: 33399083 PMCID: PMC7807940 DOI: 10.1016/j.esmoop.2020.100020] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/29/2020] [Accepted: 10/31/2020] [Indexed: 12/24/2022] Open
Abstract
Background The immunological inflammatory biomarkers for advanced hepatocellular carcinoma are unclear. We aimed to investigate the association of immunity and inflammatory status with treatment outcomes in patients with advanced hepatocellular carcinoma who received molecular-targeted agents as primary treatment. Patients and methods We enrolled 728 consecutive patients with advanced hepatocellular carcinoma who received sorafenib (n = 554) or lenvatinib (n = 174) as primary treatment in Japan between May 2009 and June 2020. Changes in the neutrophil-to-lymphocyte ratio before and 1 month after treatment and their impact on survival were evaluated. The cut-off values of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio for predicting overall and progression-free survival were calculated using receiver operating characteristic curves. Results The neutrophil-to-lymphocyte ratio, but not the platelet-to-lymphocyte ratio, was an independent prognostic factor. Patients with decreased neutrophil-to-lymphocyte ratio survived significantly longer than patients with increased neutrophil-to-lymphocyte ratio (median overall survival: 14.7 versus 10.4 months, P = 0.0110). Among patients with a low pre-treatment neutrophil-to-lymphocyte ratio, the overall survival did not differ significantly between those with decreased and those with increased neutrophil-to-lymphocyte ratio after 1 month (median: 19.0 versus 14.8 months, P = 0.1498). However, among patients with high pre-treatment neutrophil-to-lymphocyte ratio, those whose neutrophil-to-lymphocyte ratio decreased after 1 month showed significantly longer survival than those whose neutrophil-to-lymphocyte ratio increased (median: 12.7 versus 5.5 months, P < 0.0001). The therapeutic effect was not correlated with pre-treatment neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio. Conclusions The neutrophil-to-lymphocyte ratio is a prognostic factor, along with liver function and tumor markers, in patients with advanced hepatocellular carcinoma who received molecular-targeted agents as primary treatment. Thus, the neutrophil-to-lymphocyte ratio could be a prognostic biomarker for advanced hepatocellular carcinoma primarily treated with immunotherapy. NLR was an independent prognostic factor with advanced HCC, along with liver function and tumor markers. Patients with decreased NLR 1 month after treatment survived significantly longer than patients with increased NLR. The therapeutic effect was not correlated with pre-treatment NLR or PLR. NLR is a prognostic factor in patients with advanced HCC who received molecular-targeted agents as primary treatment. Thus, NLR could be a prognostic biomarker for advanced HCC treated with immunotherapy.
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Affiliation(s)
- M Nakano
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
| | - R Kuromatsu
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - T Niizeki
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - S Okamura
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - H Iwamoto
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - S Shimose
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - T Shirono
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Y Noda
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - N Kamachi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - H Koga
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - T Torimura
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
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- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
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Profiles Combining Muscle Atrophy and Neutrophil-to-Lymphocyte Ratio Are Associated with Prognosis of Patients with Stage IV Gastric Cancer. Nutrients 2020; 12:nu12061884. [PMID: 32599747 PMCID: PMC7353220 DOI: 10.3390/nu12061884] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/14/2020] [Accepted: 06/20/2020] [Indexed: 12/13/2022] Open
Abstract
We aimed to investigate the impact of muscle atrophy and the neutrophil-to-lymphocyte ratio (NLR), a sub-clinical biomarker of inflammation and nutrition, on the prognosis of patients with unresectable advanced gastric cancer. We retrospectively enrolled 109 patients with stage IV gastric cancer (median age 69 years; female/male 22%/78%; median observational period 261 days). Independent factors and profiles for overall survival (OS) were determined by Cox regression analysis and decision-tree analysis, respectively. OS was calculated using the Kaplan–Meier method. The prevalence of muscle atrophy was 82.6% and the median NLR was 3.15. In Cox regression analysis, none of factors were identified as an independent factor for survival. The decision-tree analysis revealed that the most favorable prognostic profile was non-muscle atrophy (OS rate 36.8%). The most unfavorable prognostic profile was the combination of muscle atrophy and high NLR (OS rate 19.6%). The OS rate was significantly lower in patients with muscle atrophy and high NLR than in patients with non-muscle atrophy (1-year survival rate 28.5% vs. 54.7%; log-rank test p = 0.0014). In conclusion, “muscle atrophy and high NLR” was a prognostic profile for patients with stage IV gastric cancer. Thus, the assessment of muscle mass, subclinical inflammation, and malnutrition may be important for the management of patients with stage IV gastric cancer.
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Jekarl DW, Lee S, Kwon JH, Nam SW, Kim M, Kim Y, Jang JW. Complex interaction networks of cytokines after transarterial chemotherapy in patients with hepatocellular carcinoma. PLoS One 2019; 14:e0224318. [PMID: 31751357 PMCID: PMC6874208 DOI: 10.1371/journal.pone.0224318] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 10/11/2019] [Indexed: 01/06/2023] Open
Abstract
Treating hepatocellular carcinoma with transarterial chemoembolization (TACE) induces both local inflammation in the tumor microenvironment as well as systemic inflammation. We analyzed serum cytokine response to TACE to evaluate this. Serum samples obtained from 203 HCC patients treated with TACE were analyzed for inflammatory cytokines including interleukin (IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-9, IL-10, IL-12, IL-13, IL-17, IL-22, TNF-α, IFN-γ, and C-reactive protein (CRP) levels. Cytokine concentrations were measured at day 0 (D0, baseline, n = 203), day3 (D3, n = 156), day7 (D7, n = 147), and day 60 (D60, n = 115) after TACE. Network analysis of the cytokines was performed to understand their interactive relationship. After TACE, IL-1β, -6,-9, -12, and -22 increased by D60. IL-2, -5, -10, -17A and INF-γ decreased by D60, and IL-4, -13 and TNF-α revealed stable concentration. D0 network revealed that IL-2, -4, -5, and -10 formed a module. D3 network had the highest clustering coefficient and average degree that revealed similar pattern as CRP. D7 network revealed that IL-6, -9 and CRP were isolated from the network. D60 network had the lower network heterogeneity and lower clustering coefficient, network diameter, shortest path and characteristic path length. Degree correlation revealed that assortative network turned to disassortative network by D60 indicating that the network gained scale free feature. D60 cytokine network retained inflammatory function and these parameters indicated that the systemic inflammation induced by TACE appeared to be attenuated by D60. IL-9 at D3 and D7 seemed to be related to anti-tumor effect and IL-6 at D7 and D60, and IL-22 at D60 was related to regenerative but not pro- or anti- inflammatory function. Median survival month of patient group with high and low values of cytokine with P-values were as follows: D0 CRP, 9.5 and 54.2 months (P<0.0001); D0 IL-2, 39.9 and 56.1 months (P = 0.0084); D3 CRP, 31.3 and 55.1 months (P = 0.0056); D7 CRP, 28.7 and 50.7 months (P = 0.0065), respectively. TACE is associated with systemic inflammation which appears to peak at Day 3 and resolve by D60. Among the tested cytokines, IL-6 and IL-22 appear to play a regenerative role.
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Affiliation(s)
- Dong Wook Jekarl
- Department of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Laboratory for Development and Evaluation Center, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seungok Lee
- Laboratory for Development and Evaluation Center, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Laboratory Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Hyun Kwon
- Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soon Woo Nam
- Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myungshin Kim
- Department of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Laboratory for Development and Evaluation Center, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yonggoo Kim
- Department of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Laboratory for Development and Evaluation Center, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Won Jang
- Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Huang Z, Lu W, Yu N, Yang G, Xu H, Liu H. Systemic inflammatory response predicts poor prognoses in Barcelona Clinic Liver Cancer stage B/C hepatocellular carcinoma with transarterial chemoembolization: a prospective study. Transl Cancer Res 2019; 8:2552-2563. [PMID: 35117012 PMCID: PMC8798496 DOI: 10.21037/tcr.2019.10.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 10/09/2019] [Indexed: 01/14/2023]
Abstract
Background Chronic inflammation has been demonstrated to be an important factor in the initiation, promotion, and progression of hepatocellular carcinoma (HCC). The aim of this study was to investigate the prognostic values of systemic inflammation markers in Barcelona Clinic Liver Cancer (BCLC) stage B/C HCC. Methods A prospective non-randomized study was performed from June 2016 to May 2017; 51 of 123 BCLC stage B/C HCC patients were enrolled and received transarterial chemoembolization (TACE). Clinical and laboratory data were recorded. Serum IL-6, IL-10, C-reactive protein (CRP), and blood-neutrophil-to-lymphocyte ratio (NLR) levels were analyzed during the perioperative period. Patient prognosis was investigated. Twenty-eight stage A cases and 10 stage B/C patients who received resection were also collected as controls. Results Compared to the stage A group, the BCLC stage B/C HCC patients had significantly higher serum IL-6, CRP, and blood NLR levels. Serum IL-6, IL-10, CRP, and blood NLR levels increased significantly 3 days after treatment (TACE/resection) and returned to baseline levels after 30 days. By univariate analyses, tumor size, high pretreatment serum IL-6, CRP, and blood NLR levels predicted worse progression-free survival (PFS) after TACE (log-rank test P<0.001, P=0.007, P=0.001, respectively). Multivariate analysis revealed that both high serum IL-6 (P=0.018) and CRP (P=0.042) were independent predictors of worse PFS, meanwhile blood NLR was the only inflammatory factor associated to overall survival (OS) (P=0.046). Conclusions Serum IL-6, CRP, and blood NLR levels were significantly elevated in stage B/CHCC. Serum IL-6 and CRP were independent predictors of poor PFS while NLR independently predicted worse OS in BCLC stage B/C HCC.
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Affiliation(s)
- Zhiliang Huang
- Department of Gastrointestinal Surgical Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China.,Guangzhou Key Laboratory of "Translational Medicine on Malignant Tumor Treatment", Guangzhou 510095, China
| | - Weiqun Lu
- Department of Gastrointestinal Surgical Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China.,Guangzhou Key Laboratory of "Translational Medicine on Malignant Tumor Treatment", Guangzhou 510095, China
| | - Nanrong Yu
- Department of Gastrointestinal Surgical Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China.,Guangzhou Key Laboratory of "Translational Medicine on Malignant Tumor Treatment", Guangzhou 510095, China
| | - Guohua Yang
- Department of Gastrointestinal Surgical Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China
| | - Houwei Xu
- Department of Gastrointestinal Surgical Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China
| | - Haiying Liu
- Department of Gastrointestinal Surgical Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China
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Wu MT, He SY, Chen SL, Li LF, He ZQ, Zhu YY, He X, Chen H. Clinical and prognostic implications of pretreatment albumin to C-reactive protein ratio in patients with hepatocellular carcinoma. BMC Cancer 2019; 19:538. [PMID: 31164099 PMCID: PMC6549313 DOI: 10.1186/s12885-019-5747-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 05/23/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Despite recent advances in the treatments of hepatocellular carcinoma (HCC), the prognosis of HCC patients remains controversial. The purpose of this study was to investigate the prognostic performance of pretreatment albumin to C-reactive protein ratio (ACR) in patients with HCC. METHODS This study included 409 initially diagnosed HCC patients retrospectively. The optimal cut-off points for distinguishing high and low ACR value was determined by the X-tile software. The chi-squared test was used for comparing the baseline clinicopathologic parameters in different groups and subgroups. The Cox regression with log-rank tests was used to analyze OS and DFS, and Kaplan-Meier curves was used to estimate the prognosis of HCC patients. RESULTS Patients with lower ACR were significantly correlated with advanced clinical parameters, using a cut-off points of 5.4 (high ACR, n = 236 vs. low ACR, n = 173). Multivariate analysis demonstrated that ACR was associated with OS (HR = 0.544, 95% CI: 0.385-0.769, p = 0.001), with DFS (HR = 0.550, 95% CI: 0.392-0.772, p = 0.001). Treatment exposure (HR = 2.191; 95% CI: 1.533-3.132; p < 0.001), tumor size (HR = 1.973; 95% CI: 1.230-3.164; p = 0.005), serum AFP level (HR = 1.752; 95% CI: 1.277-2.403; p = 0.001), and TNM stage (HR = 0.470; 95% CI: 0.319-2.504; p < 0.001), were independent factors for OS in HCC patients. Treatment exposure (HR = 2.244; 95% CI: 1.590-3.166; p < 0.001), TNM stage (HR = 2.075; 95% CI: 1.436-3.000; p < 0.001), serum AFP level (HR = 1.819; 95% CI: 1.340-2.469; p = 0.001), tumor size (HR = 1.730; 95% CI: 1.113-2.689; p = 0.015), and ACR (HR = 0.550; 95% CI: 0.392-0.772; p = 0.001) were independent factors for DFS in HCC patients. CONCLUSIONS Pretreatment ACR is a convenient and useful parameter for HCC patients predicting OS and DFS. Lower ACR was associated with advanced TNM stage, larger tumor size, and a high concentration of AFP. These results may help to design strategies to personalize management approaches among HCC patients.
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Affiliation(s)
- Mian-Tao Wu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Laboratory Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Su-Yin He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Shu-Lin Chen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Laboratory Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lin-Fang Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Laboratory Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zheng-Qiang He
- Department of Laboratory Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yuan-Ying Zhu
- Department of Laboratory Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xia He
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China. .,Department of Laboratory Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
| | - Hao Chen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China. .,Department of Laboratory Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
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11
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Hirakawa Y, Ogata T, Sasada T, Yamashita T, Itoh K, Tanaka H, Okuda K. Immunological consequences following splenectomy in patients with liver cirrhosis. Exp Ther Med 2019; 18:848-856. [PMID: 31281459 DOI: 10.3892/etm.2019.7640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 05/16/2019] [Indexed: 12/16/2022] Open
Abstract
The immune status in patients with liver cirrhosis is generally impaired due to concomitant hypersplenism. As the spleen is the largest lymphoid organ, deleterious events resulting from splenectomy are of concern in these patients. However, the immunological consequences after splenectomy have not yet been fully elucidated. In the present study, the immune status after splenectomy was comprehensively examined. Splenectomy was performed in 11 patients with liver cirrhosis and hypersplenism, and the immune status in peripheral blood was examined and compared before and at 1, 3 and 6 months after splenectomy. Splenectomy significantly lowered the neutrophil-to-lymphocyte ratio, due to a surge in lymphocytes in the peripheral circulation at 3 and 6 months after splenectomy. The frequency of cluster of differentiation (CD)4+ T cells decreased after splenectomy, whereas the frequency of CD8+ T cells increased. Notably, the frequencies of the naïve and central memory subsets of CD4+ and CD8+ T cells decreased, whereas those of the effector memory subset trended upward. In addition, the frequencies of other immune cells such as γδ T cells, natural killer T cells and natural killer cells transiently increased, while inhibitory cells such as regulatory T cells and myeloid-derived suppressor cells significantly decreased. T-cell responses to viral- and tumor-associated antigens increased after splenectomy in five of eight and two of five patients, respectively. To the best of our knowledge, this is the first study to precisely examine the drastic changes of immunological phenotypes in peripheral blood after splenectomy in patients with cirrhosis. Our findings suggested that splenectomy in patients with cirrhosis may ameliorate the impaired immune status, possibly by reducing suppressive cells and enhancing the effector cell population and function, which could, at least in part, explain the mechanisms responsible for the clinical benefits of splenectomy.
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Affiliation(s)
- Yusuke Hirakawa
- Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Toshiro Ogata
- Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan.,Department of Surgery, St. Mary's Hospital, Kurume, Fukuoka 830-8543, Japan
| | - Tetsuro Sasada
- Cancer Vaccine Center, Kurume University, Kurume, Fukuoka 839-0863, Japan.,Cancer Vaccine Center, Kanagawa Cancer Center, Yokohama, Kanagawa 241-8515, Japan
| | - Takuto Yamashita
- Biostatistics Center, Kurume University, Kurume, Fukuoka 830-0011, Japan
| | - Kyogo Itoh
- Cancer Vaccine Center, Kurume University, Kurume, Fukuoka 839-0863, Japan
| | - Hiroyuki Tanaka
- Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Koji Okuda
- Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
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12
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Xu G, Wu H, Xiong R, Li C, Liu C, Xu M, Xie M. Value of the preoperative neutrophil-to-lymphocyte ratio as a prognostic factor for long-term survival in postoperative esophageal squamous cell carcinoma patients. Thorac Cancer 2018; 9:1707-1715. [PMID: 30311998 PMCID: PMC6275843 DOI: 10.1111/1759-7714.12885] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/27/2018] [Accepted: 08/29/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND This study investigated the relationship between the neutrophil-to-lymphocyte ratio (NLR) and clinicopathological features and prognosis in patients with postoperative esophageal squamous cell carcinoma (ESCC). METHODS The preoperative NLR was evaluated in 419 patients who underwent esophagectomy for ESCC. A receiver operating characteristic (ROC) curve was plotted to verify the accuracy of the NLR for predicting survival. Correlation between the NLR and clinicopathological characteristics was analyzed using the χ2 test. Prognostic influence was calculated by using the Kaplan-Meier method and the difference was assessed by log-rank test. Multivariate Cox regression models were applied to evaluate the independent prognostic value. RESULTS The cutoff value of the NLR was 2.998, the area under the curve was 0.735, and the sensitivity and specificity were 69.3% and 69.3%, respectively. Tumor length (P = 0.0317), lymph node metastasis (P = 0.0352), pathological tumor node metastasis (pTNM) stage (P = 0.0271), and postoperative radiotherapy (P = 0.0385) were significantly different between the groups. Multivariate analysis showed that pTNM stage (P = 0.0098), lymph node metastasis (P = 0.001), and NLR (P = 0.0022) were independent prognostic factors for survival. Moreover, when patients were stratified by TNM stage, the adverse effects of preoperative NLR on cancer-specific survival were greater in patients with stage II and III ESCC and in patients with lymph node metastasis. CONCLUSIONS The preoperative NLR is significantly correlated with long-term prognosis in postoperative patients with ESCC, particularly in patients with lymph node metastasis and stage II and III ESCC.
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Affiliation(s)
- Guang‐wen Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina
| | - Han‐ran Wu
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina
| | - Ran Xiong
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina
| | - Cai‐wei Li
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina
| | - Chang‐qing Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina
| | - Mei‐qing Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina
| | - Ming‐ran Xie
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina
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13
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Suner A, Carr BI, Akkiz H, Karakülah G, Üsküdar O, Yalçın K, Kuran S, Tokat Y, Yilmaz S, Özakyol A, Tokmak S, Ballı T, Yücesoy M, Bahçeci Hİ, Ülkü A, Akçam T, Polat KY, Ekinci N, Şimşek H, Örmeci N, Sonsuz A, Demir M, Kılıç M, Uygun A, Demir A, Delik A, Arslan B, Doran F, Altıntaş E, Temel T, Bektaş A. C-Reactive Protein and Platelet-Lymphocyte Ratio as Potential Tumor Markers in Low-Alpha-Fetoprotein Hepatocellular Carcinoma. Oncology 2018; 96:25-32. [PMID: 30336489 DOI: 10.1159/000492473] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/25/2018] [Indexed: 11/19/2022]
Abstract
The hepatocellular carcinoma (HCC) tumor marker alpha-fetoprotein (AFP) is only elevated in about half of the HCC patients, limiting its usefulness in following the effects of therapy or screening. New markers are needed. It has been previously noted that the inflammation markers C-reactive protein (CRP) and platelet-lymphocyte ratio (PLR) are prognostically important and may reflect HCC aggressiveness. We therefore examined these 2 markers in a low-AFP HCC cohort and found that for HCCs > 2 cm, both markers significantly rise with an increasing maximum tumor diameter (MTD). We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Youden index value for each marker, and their area-under-the-curve values for each MTD group. Patients were dichotomized into 2 groups based on the CRP and PLR from the receiver-operating characteristic curve analysis. In the logistic regression models of the 4 different MTD patient groups, CRP and PLR levels were statistically significant to estimate MTD in univariate logistic regression models of MTD groups > 2 cm. CRP and PLR were then combined, and the combination was statistically significant to estimate MTD groups of 3-, 4-, and 5-cm cutoffs. CRP and PLR thus have potential as tumor markers for low-AFP HCC patients, and possibly for screening.
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Affiliation(s)
- Aslı Suner
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Brian I Carr
- Liver Transplant Institute, İnönü University, Malatya,
| | - Hikmet Akkiz
- Gastroenterology Department, Çukurova University, Adana, Turkey
| | - Gökhan Karakülah
- Liver Transplant Institute, İnönü University, Malatya, Turkey.,Izmir International Biomedicine and Genome Institute, Dokuz Eylül University Izmir, Izmir, Turkey
| | - Oguz Üsküdar
- Gastroenterology Department, Çukurova University, Adana, Turkey
| | - Kendal Yalçın
- Internal Medicine, Dicle University, Diyarbakır, Turkey
| | - Sedef Kuran
- Gastroenterology Department, Çukurova University, Adana, Turkey
| | - Yaman Tokat
- Gastroenterology Department, Çukurova University, Adana, Turkey
| | - Sezai Yilmaz
- Liver Transplant Institute, İnönü University, Malatya, Turkey
| | - Ayşegül Özakyol
- Gastroenterology, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Salih Tokmak
- Gastroenterology Department, Çukurova University, Adana, Turkey
| | - Tuğsan Ballı
- Gastroenterology Department, Çukurova University, Adana, Turkey
| | | | | | - Abdulalh Ülkü
- Gastroenterology Department, Çukurova University, Adana, Turkey
| | - Tolga Akçam
- Gastroenterology Department, Çukurova University, Adana, Turkey
| | | | - Nazım Ekinci
- Internal Medicine, Dicle University, Diyarbakır, Turkey
| | - Halis Şimşek
- Gastroenterology, Hacettepe University, Ankara, Turkey
| | | | - Abdulalh Sonsuz
- Internal Medicine, İstanbul Cerrahpaşa University, Istanbul, Turkey
| | - Mehmet Demir
- Gastroenterology, Hatay Mustafa Kemal University, Antakya, Turkey
| | - Murat Kılıç
- Liver Transplantation, Izmir Kent Hospital, Izmir, Turkey
| | - Ahmet Uygun
- Gastroenterology, Haydarpaşa Sultan Abdülhamid Eğitim Araştırma Hospital, Istanbul, Turkey
| | - Ali Demir
- Department of Gastroenterology, Konya Necmettin Erbakan University, Konya, Turkey
| | - Anıl Delik
- Gastroenterology Department, Çukurova University, Adana, Turkey
| | - Burcu Arslan
- Gastroenterology Department, Çukurova University, Adana, Turkey
| | - Figen Doran
- Gastroenterology Department, Çukurova University, Adana, Turkey
| | | | - Tuncer Temel
- Gastroenterology, Eskişehir Gazi Osman Paşa University, Eskişehir, Turkey
| | - Ahmet Bektaş
- Gastroenterology, Mayıs University, Samsun, Turkey
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14
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Platelet-to-lymphocyte ratio in advanced Cancer: Review and meta-analysis. Clin Chim Acta 2018; 483:48-56. [DOI: 10.1016/j.cca.2018.04.023] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 04/15/2018] [Accepted: 04/16/2018] [Indexed: 12/30/2022]
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15
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Wu XL, Li ZY, Bi XY, Zhao H, Zhao JJ, Zhou JG, Han Y, Huang Z, Zhang YF, Cai JQ. Human leukocyte antigen gene polymorphisms are associated with systemic inflammation in hepatitis B virus-related hepatocellular carcinoma. Cancer Manag Res 2018; 10:2315-2324. [PMID: 30104900 PMCID: PMC6074760 DOI: 10.2147/cmar.s167574] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Systemic inflammation (SI) is associated with tumor progression and overall survival (OS) in patients with hepatocellular carcinoma (HCC). The presence of some single nucleotide polymorphisms (SNPs) in the human leukocyte antigen (HLA) region can influence the prognosis of patients with hepatitis B virus (HBV)-related HCC, although the mechanism remains unknown. This study aimed to analyze the correlations between HLA gene polymorphisms and SI. Patients and methods This study included 330 patients with HCC. The clinical parameters were reviewed, and five SNPs, namely rs2647073, rs3997872, rs3077, rs7453920, and rs7768538, were genotyped using the MassARRAY system. Results The rs3997872, rs7453920, and rs7768538 genotypes were found to be significantly associated with OS (P<0.05). The rs7453920 genotype was significantly associated with the neutrophil/lymphocyte ratio (NLR; P=0.001), which was used as an SI index with a threshold determined by receiver operating characteristic analysis. An elevated NLR was also an independent predictor of OS according to univariate and multivariate analyses (P<0.001). Conclusion Our data show that HLA gene polymorphisms are associated with SI in patients with HBV-related HCC, and the absence of minor allele A (rs7453920) promotes SI and shortens OS.
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Affiliation(s)
| | - Zhi-Yu Li
- Department of Hepatobiliary Surgery,
| | - Xin-Yu Bi
- Department of Hepatobiliary Surgery,
| | - Hong Zhao
- Department of Hepatobiliary Surgery,
| | | | | | - Yue Han
- Department of Interventional Therapies, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
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16
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McDermott SM, Saunders ND, Schneider EB, Strosberg D, Onesti J, Dillhoff M, Schmidt CR, Shirley LA. Neutrophil Lymphocyte Ratio and Transarterial Chemoembolization in Neuroendocrine Tumor Metastases. J Surg Res 2018; 232:369-375. [PMID: 30463743 DOI: 10.1016/j.jss.2018.06.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 06/11/2018] [Accepted: 06/19/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND The neutrophil-to-lymphocyte ratio (NLR) has been shown to be predictive of outcomes in various cancers, including neuroendocrine tumors (NETs), and cancer-related treatments, including transarterial chemoembolization (TACE). We hypothesized that NLR could be predictive of response to TACE in patients with metastatic NET. METHODS We reviewed 262 patients who underwent TACE for metastatic NET at a single tertiary medical center from 2000 to 2016. NLR was calculated from blood work drawn 1 d before TACE, as well as 1 d, 1 wk, and 6 mo after treatment. RESULTS The median post-TACE overall survival (OS) of the entire cohort was 30.1 mo. Median OS of patients with a pre-TACE NLR ≤ 4 was 33.3 mo versus 21.1 mo for patients with a pre-TACE NLR >4 (P = 0.005). At 6 mo, the median OS for patients with post-TACE NLR > pre-TACE NLR was 21.4 mo versus 25.8 mo for patients with post-TACE NLR ≤ pre-TACE NLR (P = 0.007). On multivariate analysis, both pre-TACE NLR and 6-mo post-TACE NLR were independent predictors of survival. NLR values from 1-d and 1-wk post-TACE did not correlate with outcome. CONCLUSIONS An elevated NLR pre-TACE and an NLR that has not returned to its pre-TACE value several months after TACE correlate with outcomes in patients with NET and liver metastases. This value can easily be calculated from laboratory results routinely obtained as part of preprocedural and postprocedural care, potential treatment strategies.
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Affiliation(s)
| | - Neil D Saunders
- Emory University School of Medicine, Division of General and GI Surgery, Atlanta, Georgia
| | - Eric B Schneider
- University of Virginia Department of Surgery, Charlottesville, Virginia
| | - David Strosberg
- The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jill Onesti
- Mercy Health, Department of Surgery, Grand Rapids, Michigan
| | - Mary Dillhoff
- The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Carl R Schmidt
- The Ohio State University Wexner Medical Center, Columbus, Ohio
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17
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Suner A, Carr BI, Akkiz H, Uskudar O, Kuran S, Tokat Y, Tokmak S, Ballı T, Ulku A, AkCam T, Delik A, Arslan B, Doran F, YalCın K, Ekinci N, Yilmaz S, Ozakyol A, Yücesoy M, BahCeci HI, Polat KY, Şimsek H, Ormeci N, Sonsuz A, Demir M, KılıC M, Uygun A, Demir A, Altıntas E, Karakulah G, Temel T, Bektas A. Inflammatory markers C-reactive protein and PLR in relation to HCC characteristics. ACTA ACUST UNITED AC 2018; 5. [PMID: 30662766 PMCID: PMC6333412 DOI: 10.15761/jts.1000260] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction Several markers of systemic inflammation, including blood C-reactive protein, platelet lymphocyte ratio (PLR) and neutrophil lymphocyte ratio (NLR) have been identified as independent prognosticators for hepatocellular carcinoma (HCC). Methods To attempt to understand the significance of these markers, they were examined in relation to 4 tumour parameters, namely maximum tumour diameter (MTD), tumour multifocality, portal vein thrombosis (PVT) and blood alpha-fetoprotein (AFP) levels. Results Using linear and logistic regression models, we found that C-reactive protein and PLR on single variables, were statistically significantly related to the tumour parameters. In a logistic regression final model, CRP was significantly related to MTD, AFP and PVT, and the Glasgow Index significantly related to MTD and AFP. Results of the area under the receiver operating characteristic curves (ROC), showed that the areas for PLR and CRP were statistically significant for high versus low MTD and for presence versus absence of PVT. CRP alone was significant for high versus low AFP. Conclusions These analyses suggest that the prognostic usefulness of the inflammatory markers PLR and CRP (but not NLR) may be due to their reflection of parameter values for tumour growth and invasiveness.
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Affiliation(s)
- Aslı Suner
- Ege University, Faculty of Medicine, Department of Biostatistics and Medical Informatics, İzmir, Turkey
| | - Brian I Carr
- Liver Transplant Inst, Inonu University, Malatya, Turkey
| | - Hikmet Akkiz
- Cukurova University, Gastroenterology Department, Adana, Turkey
| | - Oguz Uskudar
- Cukurova University, Rektorlugu, 01330 Sarıcam/Adana, Turkey
| | - Sedef Kuran
- Cukurova University, Rektorlugu, 01330 Sarıcam/Adana, Turkey
| | - Yaman Tokat
- Cukurova University, Rektorlugu, 01330 Sarıcam/Adana, Turkey
| | - Salih Tokmak
- Cukurova University, Rektorlugu, 01330 Sarıcam/Adana, Turkey
| | - Tugsan Ballı
- Cukurova University, Rektorlugu, 01330 Sarıcam/Adana, Turkey
| | - Abdulalh Ulku
- Cukurova University, Rektorlugu, 01330 Sarıcam/Adana, Turkey
| | - Tolga AkCam
- Cukurova University, Rektorlugu, 01330 Sarıcam/Adana, Turkey
| | - Anıl Delik
- Cukurova University, Rektorlugu, 01330 Sarıcam/Adana, Turkey
| | - Burcu Arslan
- Cukurova University, Rektorlugu, 01330 Sarıcam/Adana, Turkey
| | - Figen Doran
- Cukurova University, Rektorlugu, 01330 Sarıcam/Adana, Turkey
| | | | | | - Sezai Yilmaz
- Inonu University Malatya, 44210 Battalgazi/Malatya, Turkey
| | - Ayşegul Ozakyol
- Eskisehir Osmangazi University, Meselik Yerleskesi, 26040 Odunpazarı/Eskisehir, Turkey
| | - Mehmet Yücesoy
- Erciyes University, Talas Blv., 38030 Melikgazi/Kayseri, Turkey
| | | | | | | | | | | | | | | | - Ahmet Uygun
- Haydarpaşa Sultan Abdülhamid Egitim Araştırma Hospital, Turkey
| | - Ali Demir
- Konya Necmettin Erbakan University, Turkey
| | | | - Gokhan Karakulah
- Izmir International Biomedicine and Genome Institute, Dokuz Eylül University, Izmir, Turkey
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18
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Du Z, Dong J, Bi J, Bai R, Zhang J, Wu Z, Lv Y, Zhang X, Wu R. Predictive value of the preoperative neutrophil-to-lymphocyte ratio for the development of hepatocellular carcinoma in HBV-associated cirrhotic patients after splenectomy. PLoS One 2018; 13:e0195336. [PMID: 29621282 PMCID: PMC5886527 DOI: 10.1371/journal.pone.0195336] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 03/20/2018] [Indexed: 12/18/2022] Open
Abstract
The neutrophil to lymphocyte ratio (NLR), a simple marker of inflammation, has recently been showed to predict tumor recurrence in hepatocellular carcinoma (HCC) patients after hepatic resection or liver transplantation. However, whether it can be used to predict HCC development in cirrhotic patients remained unknown. The aim of this study was to evaluate the predictive value of the preoperative NLR for the development of HCC in cirrhotic patients who underwent splenectomy. A total of 230 HBV-associated cirrhotic patients who underwent splenectomy in our hospital from January 2000 to December 2012 were included in this study. Detailed clinical data included patients’ general characteristics, laboratory tests and imaging studies, surgical procedures and complications. Information on patients’ follow-up data was also obtained. We found that 38 (16.52%) patients developed HCC after splenectomy during the follow-up period. An elevated preoperative NLR was associated with increased risk of developing HCC in cirrhotic patients after splenectomy. The optimal cutoff value of NLR for HCC development was 2.27. In patients who developed HCC during the follow-up period, NLR scores showed no predictive value in overall survival after splenectomy. However, NLR scores appeared to have a much better predictive value in overall survival in patients who did not develop HCC. In conclusion, cirrhotic patients who underwent splenectomy remain at a relatively high risk of developing HCC, and an elevated preoperative NLR is associated with HCC development in cirrhotic patients who underwent splenectomy for hypersplenism.
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Affiliation(s)
- Zhaoqing Du
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, Xi’an, Shaanxi Province, China
- Institute of Advanced Surgical Technology and Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
- Department of Hepatobiliary Surgery,First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Jian Dong
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, Xi’an, Shaanxi Province, China
- Institute of Advanced Surgical Technology and Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
- Department of Hepatobiliary Surgery,First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Jianbin Bi
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, Xi’an, Shaanxi Province, China
- Institute of Advanced Surgical Technology and Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
- Department of Hepatobiliary Surgery,First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Ruhai Bai
- Department of Epidemiology and Biostatistics, Xi’an Jiaotong University School of Public Health, Xi’an, Shaanxi Province, China
| | - Jia Zhang
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, Xi’an, Shaanxi Province, China
- Institute of Advanced Surgical Technology and Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
- Department of Hepatobiliary Surgery,First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Zheng Wu
- Department of Hepatobiliary Surgery,First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Yi Lv
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, Xi’an, Shaanxi Province, China
- Institute of Advanced Surgical Technology and Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
- Department of Hepatobiliary Surgery,First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Xufeng Zhang
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, Xi’an, Shaanxi Province, China
- Institute of Advanced Surgical Technology and Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
- Department of Hepatobiliary Surgery,First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
- * E-mail: (WR); (ZX)
| | - Rongqian Wu
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, Xi’an, Shaanxi Province, China
- Institute of Advanced Surgical Technology and Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
- * E-mail: (WR); (ZX)
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19
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Xu ZG, Ye CJ, Liu LX, Wu G, Zhao ZX, Wang YZ, Shi BQ, Wang YH. The pretransplant neutrophil-lymphocyte ratio as a new prognostic predictor after liver transplantation for hepatocellular cancer: a systematic review and meta-analysis. Biomark Med 2018; 12:189-199. [PMID: 29327595 DOI: 10.2217/bmm-2017-0307] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
AIM Recently, many reports showed that the pretransplant neutrophil-lymphocyte ratio (NLR) may be correlated with the prognosis of patients undergoing liver transplantation (LT) for hepatocellular cancer (HCC). However, their results still remained controversial. Thus we performed a meta-analysis of 13 studies to estimate the prognostic value of pretransplant NLR. METHODS Databases including PubMed, Embase, Cochrane Library and Web of Science were searched to September 2017. Hazard ratio (HR) or odds ratio (OR) with its 95% CI was used to evaluate the association between elevated NLR and the prognosis or clinical features of liver cancer patients. RESULTS A total of 13 studies including 1936 patients were included in this meta-analysis. Elevated pretransplant NLR had a close association with the overall survival (HR: 2.22; 95% CI: 1.34-3.68), recurrence-free survival (HR: 3.77; 95% CI: 2.01-7.06) and disease-free survival (HR: 2.51; 95% CI: 1.22-5.15) of patients undergoing LT for HCC, respectively. In addition, elevated NLR was associated with the presence of vascular invasion (OR: 2.39; 95% CI: 1.20-4.77) and Milan criteria (OR: 0.26; 95% CI: 0.17-0.40). CONCLUSION The results of this meta-analysis showed that elevated pretransplant NLR may be used as a new prognostic predictor after LT for HCC.
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Affiliation(s)
- Zheng-Guang Xu
- Department of General Surgery, Qinghai Provincial People's Hospital, Xi'ning 810000, China
| | - Cheng-Jie Ye
- Department of General Surgery, Qinghai Provincial People's Hospital, Xi'ning 810000, China
| | - Lin-Xun Liu
- Department of General Surgery, Qinghai Provincial People's Hospital, Xi'ning 810000, China
| | - Gang Wu
- Department of General Surgery, Qinghai Provincial People's Hospital, Xi'ning 810000, China
| | - Zhan-Xue Zhao
- Department of General Surgery, Qinghai Provincial People's Hospital, Xi'ning 810000, China
| | - Yong-Zhen Wang
- Department of General Surgery, Qinghai Provincial People's Hospital, Xi'ning 810000, China.,Department of Clinical Medicine, The Clinical Medical College of Qinghai University, Xi'ning 810000, China
| | - Bing-Qiang Shi
- Department of General Surgery, Qinghai Provincial People's Hospital, Xi'ning 810000, China.,Department of Clinical Medicine, The Clinical Medical College of Qinghai University, Xi'ning 810000, China
| | - Yong-Hong Wang
- Department of General Surgery, Qinghai Provincial People's Hospital, Xi'ning 810000, China
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20
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Carr BI, Akkiz H, Guerra V, Üsküdar O, Kuran S, Karaoğullarından Ü, Tokmak S, Ballı T, Ülkü A, Akçam T, Delik A, Arslan B, Doran F, Yalçın K, Altntaş E, Özakyol A, Yücesoy M, Bahçeci Hİ, Polat KY, Ekinci N, Şimşek H, Örmeci N, Sonsuz A, Demir M, Kılıç M, Uygun A, Demir A, Yilmaz S, Tokat Y. C-reactive protein and hepatocellular carcinoma: analysis of its relationships to tumor factors. ACTA ACUST UNITED AC 2018; 15:625-634. [PMID: 29951199 DOI: 10.4172/clinical-practice.1000409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
C-reactive protein (CRP) is a blood marker for inflammation and is an independent prognostic factor for many human cancers. Combined with albumin levels, it forms the basis of the Glasgow Index for cancer prognosis. We reviewed the literature on CRP and HCC and also evaluated blood CRP levels and combination CRP plus albumin levels in a large HCC cohort. In order to understand the prognostic significance of CRP, we retrospectively examined a large HCC cohort and examined the relationship of CRP levels to tumor parameters. We report, that CRP alone and CRP plus albumin combined as well, significantly correlated with parameters of HCC aggressiveness, such as maximum tumor dimension (MTD), portal vein thrombosis (PVT) and blood alpha-fetoprotein (AFP) levels, both as individual parameters and all parameters together (Aggressiveness Index). This extends current thinking, to suggest a possible explanation for the usefulness of blood CRP levels in HCC prognostication.
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Affiliation(s)
- Brian I Carr
- Izmir Biomedicine and Genome Institute, Dokuz Eylul University, Izmir, Turkey, and Liver
Transplant Institute, Inonu University, Malatya, Turkey
| | - Hikmet Akkiz
- Çukurova University Gastroenterology Department, Adana, Turkey
| | - Vito Guerra
- Trials Centre, National Institute for Digestive Diseases, IRCCS "Saverio de Bellis", Castellana, Bari, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ahmet Uygun
- Haydarpaşa sultan Abdülhamid Eğitm Araştrma Hastanesi, Turkey
| | - Ali Demir
- Konya Necmetn Erbakan Üniversitesi, Turkey
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21
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Min GT, Li YM, Yao N, Wang J, Wang HP, Chen W. The pretreatment neutrophil-lymphocyte ratio may predict prognosis of patients with liver cancer: A systematic review and meta-analysis. Clin Transplant 2017; 32. [PMID: 29112283 DOI: 10.1111/ctr.13151] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND At present, several studies have reported that the pretreatment neutrophil-lymphocyte ratio (NLR) may be associated with the prognosis of liver cancer. Nevertheless, their conclusions remain controversial. Thus, we performed a meta-analysis of 54 studies to evaluate the prognostic value of NLR. METHOD Databases including PubMed, Embase, Cochrane Library, and Web of Science were searched to July 2017. RESULT A total of 54 studies including 12 979 patients were included in this meta-analysis. Elevated NLR had a close relationship with the overall survival (OS) (HR 1.52; 95% CI 1.39-1.67), recurrence-free survival (RFS) (HR 1.84; 95% CI 1.48-2.30), and disease-free survival (DFS) (HR 1.71; 95% CI 1.39-2.11) of liver cancer, respectively. In addition, elevated NLR was associated with the presence of tumor vascular invasion (OR 2.35; 95% CI 1.93-2.86), multiple tumors (OR 1.38; 95% CI 1.15-1.66), alpha-fetoprotein ≥ 400 ng/mL (OR 1.51; 95% CI 1.15-1.98), presence of HbsAg (+) (OR 0.68; 95% CI 0.51-0.90), and cirrhosis (OR: 0.59; 95% CI 0.44-0.80). CONCLUSION This meta-analysis indicated that elevated NLR may be an effective and noninvasive indicator for prognosis of patients with liver cancer.
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Affiliation(s)
- Guang-Tao Min
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China.,The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Yu-Min Li
- Department of general Surgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Nan Yao
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Jun Wang
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Hong-Peng Wang
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Wei Chen
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
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22
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Gonda K, Shibata M, Sato Y, Washio M, Takeshita H, Shigeta H, Ogura M, Oka S, Sakuramoto S. Elevated neutrophil-to-lymphocyte ratio is associated with nutritional impairment, immune suppression, resistance to S-1 plus cisplatin, and poor prognosis in patients with stage IV gastric cancer. Mol Clin Oncol 2017; 7:1073-1078. [PMID: 29285377 DOI: 10.3892/mco.2017.1438] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 09/28/2017] [Indexed: 02/07/2023] Open
Abstract
Gastric cancer continues to be a major cause of morbidity and mortality worldwide. Recently, there has been a growing interest in the host inflammatory response and there is increasing evidence that the neutrophil to lymphocyte ratio (NLR), which is a useful marker of systemic inflammation, can be an effective prognostic indicator in various types of malignant diseases. A total of 110 patients with stage IV gastric cancer who received chemotherapy of S-1 plus cisplatin were enrolled in this study. Eleven patients did not complete four cycles of the chemotherapy. The patients were divided into two groups with 3.0 of NLR. The percentage of patients with a partial response to chemotherapy was significantly higher in the group of patients with a lower NLR (<3) (19.1 vs. 38.5%, high vs. low NLR group, respectively; P<0.05). The percentage of patients with progressive disease was higher in the high vs. low NLR group (57.4 vs. 25.0%, respectively; P<0.05). NLR levels were significantly inversely correlated with serum levels of prealbumin (P<0.01) and retinol binding protein (P<0.05). NLR levels were also significantly correlated with c-reactive protein levels (P<0.05), white blood cell count (P<0.05) and inversely with the stimulation index (a marker of cell-mediated immune function; P<0.05). Overall survival was significantly longer in patients with a lower NLR (≤ 3.0) than in those with a higher NLR (>3.0). The present study demonstrated that the NLR is a useful marker for resistance to chemotherapy, malnutrition, systemic inflammation and immune suppression. Moreover, the NLR was demonstrated to be a strong prognostic indicator in these patients.
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Affiliation(s)
- Kenji Gonda
- Department of Surgery, Japan Community Healthcare Organization, Nihonmatsu Hopsital, Nihonmatsu, Fukushima 964-8501, Japan.,Department of Gastroenterological Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Masahiko Shibata
- Department of Gastroenterological Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan.,Department of Advanced Cancer Immunotherapy, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Yu Sato
- Department of Gastroenterological Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan.,Department of Surgery, Toho University Sakura Medical Center, Sakura, Chiba 285-8741, Japan
| | - Maria Washio
- Department of Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan.,Department of Surgery, Kitasato University, Sagamihara, Kanagawa 252-0375, Japan
| | - Hiroyuki Takeshita
- Department of Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan.,Department of Surgery, Matsushita Memorial Hospital, Moriguchi, Osaka 570-8540, Japan
| | - Hirofumi Shigeta
- Department of Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan.,Department of Surgery, Toshima Hospital, Sakae, Tokyo 173-0015, Japan
| | - Michikazu Ogura
- Department of Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan.,Department of Surgery, Kasukabe Medical Center, Kasukabe, Saitama 344-8588, Japan
| | - Shinichi Oka
- Department of Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan.,Department of Surgery, Juntendo University School of Medicine, Hongo, Tokyo 113-8431, Japan
| | - Shinich Sakuramoto
- Department of Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
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23
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Yang D, Xie Y, Pan H, Huang Y, Dai Y, Tong Y, Chen M. Clinical characteristics and prognostic factors of liver cirrhosis patients with systemic inflammatory response syndrome. Hepatol Res 2017; 47:1174-1185. [PMID: 28249358 DOI: 10.1111/hepr.12886] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 02/25/2017] [Accepted: 02/27/2017] [Indexed: 12/21/2022]
Abstract
AIM Our objective is to study the clinical characteristics of cirrhosis patients with SIRS and investigate its prognostic factors. METHODS We analyzed 285 consecutive patients and their data were evaluated retrospectively. Data were compared in patients with/without SIRS during hospitalization. Univariate and multivariate Cox regression analyses were undertaken separately for cirrhotic patients with SIRS to assess predictive factors for 90-day mortality. RESULTS The mortality was 38.24% (52/136) in patients with SIRS and 6.04% (9/149) in patients without SIRS for 90-day follow-up (P < 0.001). The univariate analysis showed gastrointestinal hemorrhage (P < 0.001), hepatic encephalopathy (P < 0.001), albumin <30 g/L (P < 0.037), creatinine (Cr) >175 µmol/L (P < 0.001), cholinesterase(ChE) activity <3000 U/L (P = 0.019), white blood cell count ≥10 000 (109/L) (P = 0.018), neutrophils ≥80% (P = 0.018), C-reactive protein (CRP) ≥25 mg/L (P < 0.001), procalcitonin ≥1.0 ng/mL (P = 0.007), Child-Pugh class C (P < 0.001), septicemia (P < 0.001), pulmonary infection (P < 0.001),multi-site infection (P = 0.001), acute-on-chronic liver failure (ACLF) (P < 0.001), and advanced hepatocellular carcinoma (HCC) (P < 0.001). In multivariate analysis, only Cr ≥175 µmol/L (hazard ratio [HR] = 2.768; confidence interval [CI], 1.53-5.04; P = 0.001), C-reactive protein ≥25 mg/L (HR = 3.179; CI, 1.772-7.03; P = 0.004), multi-site infection (HR = 19.427; CI, 7.484-50.431; P < 0.001), ACLF (HR = 7.308; CI, 3.048-17.521; P < 0.001), advanced HCC (HR = 2.523; CI, 1.019-6.248; P = 0.045) were independent predictors of 90-day mortality in cirrhotic patients with SIRS. CONCLUSION Cr ≥ 175 µmol/L, CRP ≥ 25 mg/L, multi-site infection, ACLF, and advanced HCC independently predicted a higher rate of 90-day mortality in liver cirrhosis with SIRS.
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Affiliation(s)
- Danhong Yang
- Department of Infectious Diseases, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Yuanjun Xie
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Hongying Pan
- Department of Infectious Diseases, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Yicheng Huang
- Department of Infectious Diseases, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Yining Dai
- Department of Infectious Diseases, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Yongxi Tong
- Department of Infectious Diseases, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Meijuan Chen
- Department of Infectious Diseases, Zhejiang Provincial People's Hospital, Hangzhou, China
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24
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Zhao Y, Si G, Zhu F, Hui J, Cai S, Huang C, Cheng S, Fathy AH, Xiang Y, Li J. Prognostic role of platelet to lymphocyte ratio in hepatocellular carcinoma: a systematic review and meta-analysis. Oncotarget 2017; 8:22854-22862. [PMID: 28206965 PMCID: PMC5410268 DOI: 10.18632/oncotarget.15281] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 01/29/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS Several studies were conducted to explore the prognostic significance of platelet to lymphocyte ratio (PLR) in hepatocellular carcinoma (HCC), however, contradictory results across most reports were documented. To this end, we present a systematic review that aims to summarize the prognostic significance of PLR in patients with HCC. RESULTS A total of 10 studies involving a total of 2,315 patients were identified. The Newcastle-Ottawa Quality Assessment Scale (NOS) of each included study was greater than or equal to 5. The results indicated that high PLR was significantly associated with a worse OS when compared to the low PLR (HR = 1.60, 95% CI = 1.23-2.08, p = 0.0005; I2 = 88%, p < 0.00001). Similar results were detected in the subgroup analysis of the analysis model, cut-off value, ethnicity, sample size and therapy. However, no obvious correlation between the PLR and DFS/RFS in patients with HCC was observed (HR = 1.21, 95% CI = 0.87-1.67, p = 0.26; I2 = 61%, p = 0.07). MATERIALS AND METHODS A complete literature search in the PubMed, Cochrane Library and Embase database was performed. Retrospective and prospective studies focusing on the role of PLR on the prognosis in HCC were all deemed as "suitable" for our scope. The endpoints determined were: the overall survival (OS), disease-free survival (DFS), recurrence-free survival (RFS) and the progress free survival (PFS). CONCLUSIONS The study revealed that high PLR is an unfavorable predictor of OS in patients with HCC, and high PLR is a promising prognostic biomarker for HCC, especially for patients in Asia.
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Affiliation(s)
- Yongzhao Zhao
- School of Medicine, Tongji University, Shanghai, China
| | - Guangyan Si
- Department of Interventional Radiology, Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
| | - Fengshang Zhu
- Department of Gastroenterology, Tongji Hospital, Tongji University, Shanghai, China
| | - Jialiang Hui
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shangli Cai
- Mental Health Institute of the Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Hunan, China
| | | | - Sijin Cheng
- School of Medicine, Tongji University, Shanghai, China
| | | | - Yi Xiang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jing Li
- Department of Gastroenterology, Tongji Hospital, Tongji University, Shanghai, China
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25
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Zhao Q, Zhang GL, Zhu X, Su D, Huang ZL, Hu ZX, Peng L. The paradoxical changes of membrane and soluble herpes virus entry mediator in hepatocellular carcinoma patients. J Gastroenterol Hepatol 2017; 32:1520-1524. [PMID: 27987232 DOI: 10.1111/jgh.13678] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 12/04/2016] [Accepted: 12/13/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIM The herpes virus entry mediator (HVEM) network has become new directions in targeting novel checkpoint inhibitors for cancer therapy. However, the changes of membrane-bound HVEM (mHVEM) and soluble HVEM (sHVEM) in hepatocellular carcinoma (HCC) are not fully understood. This study aims to study the changes of mHVEM and sHVEM in HCC patients. METHODS Serum samples were collected from 65 HCC patients, from which sHVEM levels were examined by enzyme-linked immunosorbent assay. Expressions of mHVEM on peripheral lymphocytes from 20 HCC patients were determined using flow cytometry, and associations between mHVEM on T and B cells were analyzed. RESULTS The levels of mHVEM were downregulated on peripheral lymphocytes in HCC patients, with a strong positive correlation between mHVEM expression on T and B cells. In contrast, the levels of soluble HVEM were upregulated in the serum of HCC patients. Furthermore, we found that the increase in sHVEM level was correlated with advanced stages HCC. CONCLUSION Our data demonstrated paradoxical changes of membrane and soluble HVEM in the peripheral blood of HCC patients for the first time. These data supported the notion that roles of HVEM are likely to be immunosuppressive rather than activating tumor immunity. Future studies are warranted to further explore the translational values of mHVEM and sHVEM in peripheral blood as diagnostic markers and therapeutic targets.
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Affiliation(s)
- Qiyi Zhao
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Geng-Lin Zhang
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiang Zhu
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Di Su
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhan-Lian Huang
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhao-Xia Hu
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liang Peng
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Cell-gene Therapy Translational Medicine Research Center, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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26
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Yu Y, Song J, Zhang R, Liu Z, Li Q, Shi Y, Chen Y, Chen J. Preoperative neutrophil-to-lymphocyte ratio and tumor-related factors to predict microvascular invasion in patients with hepatocellular carcinoma. Oncotarget 2017; 8:79722-79730. [PMID: 29108352 PMCID: PMC5668085 DOI: 10.18632/oncotarget.19178] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 06/29/2017] [Indexed: 02/07/2023] Open
Abstract
Small hepatocellular carcinoma (HCC) is less invasive and has a better prognosis, but it still has a high recurrence rate. Microvascular invasion (MVI), as a poor prognostic indicator, is of great importance for treating of patients with HCC. The objective of the present study was to evaluate the predictive value of preoperative neutrophil-to-lymphocyte ratio and possible clinical parameters to MVI in patients with HCC. A total of 157 operable patients with HCC having a tumor diameter of less than or equal to 5 cm were enrolled in this study. The utility of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and other clinical parameters was evaluated using receiver operating characteristic curves. MVI was identified as an independent influencing factor for disease-free survival in patients with HCC who underwent curative resection, using the multivariate Cox proportional hazards regression model. The independent parameters associated with MVI were determined using logistic analysis. Multivariate analyses indicated that the neutrophil-to-lymphocyte ratio [hazard ratio, 1.705; 95% confidence interval, 0.467–6.232; P = 0.022)], platelet-to-lymphocyte ratio (hazard ratio, 1.048; 95% confidence interval, 1.006–1.092; P = 0.025), and a-fetoprotein (hazard ratio, 1.012; 95% confidence interval, 1.003–1.021; P = 0.007) were significantly associated with MVI independently. Therefore, this study concluded that the preoperative neutrophil-to-lymphocyte ratio and a-fetoprotein might serve as useful biomarkers for predicting MVI in patients with HCC.
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Affiliation(s)
- Yanlong Yu
- Department of General Surgery, Chifeng Municipal Hospital, Inner Mongolia Medical University institute of clinical, Chifeng 024000, Inner Mongolia Autonomous Region, China
| | - Jiuling Song
- Department of General Surgery, Chifeng Municipal Hospital, Inner Mongolia Medical University institute of clinical, Chifeng 024000, Inner Mongolia Autonomous Region, China
| | - Ran Zhang
- Department of General Surgery, Chifeng Municipal Hospital, Inner Mongolia Medical University institute of clinical, Chifeng 024000, Inner Mongolia Autonomous Region, China
| | - Zhonghua Liu
- Department of General Surgery, Chifeng Municipal Hospital, Inner Mongolia Medical University institute of clinical, Chifeng 024000, Inner Mongolia Autonomous Region, China
| | - Qiang Li
- Department of General Surgery, Chifeng Municipal Hospital, Inner Mongolia Medical University institute of clinical, Chifeng 024000, Inner Mongolia Autonomous Region, China
| | - Ying Shi
- Department of General Surgery, Chifeng Municipal Hospital, Inner Mongolia Medical University institute of clinical, Chifeng 024000, Inner Mongolia Autonomous Region, China
| | - Ying Chen
- Department of General Surgery, Chifeng Municipal Hospital, Inner Mongolia Medical University institute of clinical, Chifeng 024000, Inner Mongolia Autonomous Region, China
| | - Jinming Chen
- Department of General Surgery, Chifeng Municipal Hospital, Inner Mongolia Medical University institute of clinical, Chifeng 024000, Inner Mongolia Autonomous Region, China
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27
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Sato Y, Gonda K, Harada M, Tanisaka Y, Arai S, Mashimo Y, Iwano H, Sato H, Ryozawa S, Takahashi T, Sakuramoto S, Shibata M. Increased neutrophil-to-lymphocyte ratio is a novel marker for nutrition, inflammation and chemotherapy outcome in patients with locally advanced and metastatic esophageal squamous cell carcinoma. Biomed Rep 2017; 7:79-84. [PMID: 28685065 DOI: 10.3892/br.2017.924] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 05/22/2017] [Indexed: 12/14/2022] Open
Abstract
Esophageal squamous cell carcinoma (ESCC) is one of the most common types of cancer, and its progression is strongly influenced by the presence of inflammation. Recently, there has been growing interest in the host inflammatory response, and increasing evidence has indicated that the neutrophil-to-lymphocyte ratio (NLR), a useful marker of systemic inflammation, may be an effective prognostic indicator in various types of malignant diseases. In the present study, 260 patients with ESCC were enrolled, including 110 who received chemoradiation therapy (CRT) involving irradiation and chemotherapy of 5-fluorouracil and cisplatin, and 150 received chemotherapy using 5-fluorouracil and cisplatin (FP). The patients of each group were both divided into two groups according to their NLR: High NLR (NLR>3.0) and low NLR (NLR≤3.0). Serum levels of prealbumin and retinol binding protein, which are nutritional parameters, were both significantly inversely correlated with NLR in patients treated with CRT, and patients treated with FP. Levels of CRP, a marker of inflammation, were significantly correlated with NLR, and stimulation indices, markers of immune reactions, were inversely correlated with NLR in both of CRT patients and FP patients. In patients treated with CRT, a partial response was significantly higher in patients with a low NLR and with progressive disease compared to those with a high NLR. In patients treated with FP, a partial response was also significantly higher in patients with a low NLR and with progressive disease compared to those with a high NLR. The overall survival of patients with CRT and FP were both significantly worse in patients with a high NLR than in those with a low NLR. NLR may serve as a useful marker of the tumor response, immune suppression, malnutrition and prognosis upon CRT or FP in patients with locally advanced or metastatic ESCC.
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Affiliation(s)
- Yu Sato
- Department of Surgery, Toho University Sakura Medical Center, Sakura, Chiba 285-8741, Japan.,Department of Gastroenterological Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Kenji Gonda
- Department of Gastroenterological Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan.,Department of Surgery, Japan Community Healthcare Organization, Nihonmatsu Hospital, Nihonmatsu, Fukushima 964-8501, Japan
| | - Maiko Harada
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Yuki Tanisaka
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Shin Arai
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Yumi Mashimo
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Hirotoshi Iwano
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Hiroshi Sato
- Department of Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Shomei Ryozawa
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Takao Takahashi
- Department of Palliative Medicine, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Shinichi Sakuramoto
- Department of Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Masahiko Shibata
- Department of Advanced Cancer Immunotherapy, Fukushima Medical University, Fukushima, Fukushima 960-1259, Japan
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