Using Pre-Treatment Neutrophil-to-Lymphocyte Ratio to Predict the Prognosis of Young Patients with Hepatocellular Carcinoma Implemented Minimally Invasive Treatment

摘要

Purpose: Neutrophil-to-lymphocyte ratio (NLR) is considered as a prognostic factor in some patients with hepatocellular carcinoma (HCC). This factor has not been extensively examined in young HCC patients. The objective of this study is to assess whether pre-treatment NLR could predict the survival in young HCC patients implemented minimally invasive treatment. Methods: Young HCC patients treated by transarterial chemoembolization (TACE) combined with radio-frequency ablation (RFA) at our institutes from 2008 to 2017 were retrospectively reviewed. The best cutoff value of NLR was determined with time-dependent receiver operating characteristic curve analysis. The associations between overall survival and various potential risk factors, including tumor size, vascular invasion, hepatitis B virus infection, Child-Pugh scores, Barcelona Clinic Liver Cancer (BCLC) stage, aspartate ami-notransferase (AST), and NLR, were analyzed. Results: Data were collected from 47 HCC patients who were < 45 years old (range 30-44). In univariate analysis, vascular invasion (p = 0.001), tumor maximum diameter (p = 0.000), BCLC stage (p = 0.001), HBsAg positive 0 = 0.025), AST >=2x upper limits of normal (ULN) (p = 0.027), and NLR >=3.09 (p = 0.027) were predictors for poor survival in young HCC patients treated by TACE combined with RFA. The multivariate Cox proportional hazard model analysis showed that except NLR (hazard ratio [HR] = 0.720, 95% CI 0.287-1.808, p = 0.485), tumor maximum diameter >= 5 cm (HR = 0.444, 95% CI 0.199-0.991, p = 0.047) and AST >= 2 x ULN (HR = 4.578, 95% CI 1.544-13.575, p = 0.006) were independent indicators for poor prognosis. Conclusion: Pre-treatment NLR >=3.09 is related to poor prognosis of young HCC patients implemented minimally invasive treatment. However, it is not an independent indicator for prognosis.