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The Relationship Between Blood Neutrophil to Lymphocyte Ratio and Tumor Size, Tumor Number, Macrovascular Invasion in Patients with Hepatocellular Carcinoma

Year 2019, Volume: 3 Issue: 3, 207 - 212, 26.10.2019
https://doi.org/10.30565/medalanya.551550

Abstract

Aim: We aimed to show the relationship between blood neutrophil to lymphocyte ratio that is systemic inflammatory marker and tumor size, tumor number, macro-vascular invasion at the time of diagnosis in patients with hepatocellular carcinoma.

Methods: A total 48 patients diagnosed with hepatocellular carcinoma were included in our study. The patients were divided into two groups according to the median neutrophil to lymphocyte ratio.

Results: A total of 48 patients (11 female, 37 male) were included in our study. The mean age of the patients were 67.18±9.51 years-old. The median neutrophil to lym-phocyte ratio was 3.17. There were significant association between neutrophil to lym-phocyte ratio > 3.17 and macrovascular invasion, the tumor number> 3, the tumor size> 5 cm, Child-Turcot-Pugh score, Model for End-stage Liver Disease- Sodium score, C-reactive protein and blood sodium level (p: 0.005, p: 0.009, p< 0.001, p: 0.003, p:0.008, p: 0.035 and p < 0.001, respectively). Multiple logistic lineer regres-sion analysis showed that NLR> 3.17 was an independent predictor of tumor size> 5 cm and hyponatremia in patients with hepatocellular carcinoma (p: 0.010, p: 0.012, respectively).

Conclusions: The value of blood neutrophil to lymphocyte ratio at the time of diag-nosis in patients with hepatocellular carcinoma was a good predictor of tumor size and grade of disease. 

References

  • 1. Bosch FX, Ribes J, Cleries R, Diaz M. Epidemiology of hepatocellular carcinoma. Clin Liver Dis. 2005;9:191-211. doi: 10.1016/j.cld.2004.12.009.
  • 2. Forner A, Reig ME, de Lope CR, Bruix J. Current strategy for staging and treatment: the BCLC update and future prospects. Semin Liver Dis. 2010;30:61–74. doi: 10.1055/s-0030-1247133.
  • 3. Yao FY, Ferrell L, Bass NM, Watson JJ, Bacchetti P, Venook A, et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatol. 2001;33:1394-403. doi:10.1053/jhep.2001.24563.
  • 4. Tsochatzis EA, Germani G, Burroughs AK. Transarterial chemoembolization, transarterial chemotherapy, and intra-arterial chemotherapy for hepatocellular carcinoma treatment. Semin Oncol. 2010;37:89-93. doi: 10.1053/j.seminoncol. 2010.03.007.
  • 5. Duvoux C, Roudot-Thoraval F, Decaens T, Pessione F, Badran H, Piardi T, et al. Liver transplantation for hepatocellular carcinoma: a model including alpha-fetoprotein improves the performance of Milan criteria. Gastroenterol. 2012;143:986-94e3. doi: 10.1053/j.gastro.2012.05.052.
  • 6. Koh CH, Bhoo-Pathy N, Ng KL, Jabir RS, Tan GH, See MH, et al. Utility of pre-treatment neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as prognostic factors in breast cancer. Brit J Cancer. 2015;113:150-8. doi: 10.1038/bjc.2015.183.
  • 7. Aliustaoglu M, Bilici A, Ustaalioglu BB, Konya V, Gucun M, Seker M, et al. The effect of peripheral blood values on prognosis of patients with locally advanced gastric cancer before treatment. Med Oncol. 2010;27:1060-5. doi: 10.1007/s12032-009-9335-4.
  • 8. Xu ZG, Ye CJ, Liu LX, Wu G, Zhao ZX, Wang YZ, et al. 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(2):189-99. doi: 10.2217/bmm-2017-0307.
  • 9. Liu C, Jia BS, Zou BW, Du H, Yan LN, Yang JY, et al. Neutrophil-to-lymphocyte and aspartate-to-alanine aminotransferase ratios predict hepatocellular carcinoma prognosis after transarterial embolization. Medicine (Baltimore). 2017;96(45):e8512. doi: 10.1097/MD.0000000000008512.
  • 10. Jordi Bruix, Morris Sherman. Management of Hepatocellular Carcinoma: An Update. Hepatology. 2011;53(3):1020-2. doi: 10.1002/hep.24199.
  • 11. Freeman RB Jr, Wiesner RH, Harper A, McDiarmid SV, Lake J, Edwards E. The new liver allocation system: moving toward evidence-based transplantation policy. Liver Transpl 2002;8:851-8. doi: 10.1053/jlts.2002.35927.
  • 12. Pang Q, Zhou L, Qu K, Cui RX, Jin H, Liu HC. Validation of inflammation-based prognostic models in patients with hepatitis B-associated hepatocellular carcinoma: a retrospective observational study. Eur J Gastroenterol Hepatol. 2018;30(1):60-70. doi: 10.1097/MEG.0000000000001021.
  • 13. Zheng J, Cai J, Li H, Zeng K, He L, Fu H, et al. Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio as Prognostic Predictors for Hepatocellular Carcinoma Patients with Various Treatments: a Meta-Analysis and Systematic Review. Cell Physiol Biochem. 2017;44(3):967-81. doi: 10.1159/000485396.
  • 14. He CB, Lin XJ. Inflammation scores predict the survival of patients with hepatocellular carcinoma who were treated with transarterial chemoembolization and recombinant human type-5 adenovirus H101. 2017;12(3):e0174769. doi: 10.1371/journal.pone.0174769.
  • 15. Tandon P, Garcia-Tsao G. Prognostic indicators in hepatocellular carcinoma: a systematic review of 72 studies. Liver Int. 2009;29:502–10. doi: 10.1111/j.1478-3231.2008.01957.x.
  • 16. Giuseppe M, Silvana E, Ascanio M, Antonio G, Vincenza A, Anna P, et al. A new prognostic system for hepatocellular carcinoma: a retrospective study of 435 patients: the Cancer of the Liver Italian Program (CLIP) investigators. Hepatol. 1998;28:751–5. doi: 10.1002/hep.510280322.
  • 17. Yau T, Tang VY, Yao TJ, Fan ST, Lo CM, Poon RT. Development of Hong Kong Liver Cancer staging system with treatment stratification for patients with hepatocellular carcinoma. Gastroenterol. 2014;146:1691–1700. doi: 10.1053/j.gastro.2014.02.032.
  • 18. Kudo M, Chung H, Osaki Y. Prognostic staging system for hepatocellular carcinoma (CLIP score): its value and limitations, and a proposal for a new staging system, the Japan Integrated Staging Score (JIS score) J Gastroenterol. 2003;38:207–15. doi: 10.1007/s005350300038.
  • 19. Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and cancer. Cell. 2010;140:883-99. doi: 10.1016/j.cell.2010.01.025.
  • 20. Wu Y, Zhao Q, Peng C, Sun L, Li XF, Kuang DM. Neutrophils promote motility of cancer cells via a hyaluronan-mediated TLR4/PI3K activation loop. J Pathol. 2011;225:438-47. doi: 10.1002/path.2947.
  • 21. Jablonska J, Leschner S, Westphal K, Lienenklaus S, Weiss S. Neutrophils responsive to endogenous IFN-beta regulate tumor angiogenesis and growth in a mouse tumor model. J Clin Invest. 2010;120:1151–64. doi: 10.1172/JCI37223.
  • 22. Nind AP, Nairn RC, Rolland JM, Guli EP, Hughes ES. Lymphocyte anergy in patients with carcinoma. Br J Cancer. 1973;28:108–17. PMC2008880
  • 23. Wang Q, Blank S, Fiel MI, Kadri H, Luan W, Warren L, et al. The Severity of Liver Fibrosis Influences the Prognostic Value of Inflammation-Based Scores in Hepatitis B-Associated Hepatocellular Carcinoma. Ann Surg Oncol. 2015;22Suppl 3:S1125-32. doi: 10.1245/s10434-015-4598-9.
  • 24. Oh BS, Jang JW, Kwon JH, You CR, Chung KW, Kay CS, et al. Prognostic value of C-reactive protein and neutrophil-to-lymphocyte ratio in patients with hepatocellular carcinoma. BMC Cancer. 2013;13:78. doi: 10.1186/1471-2407-13-78.
  • 25. Yoshizumi T, Ikegami T, Yoshiya S, Motomura T, Mano Y, Muto J, et al. Impact of tumor size, number of tumors and neutrophil-to-lymphocyte ratio in liver transplantation for recurrent hepatocellular carcinoma. Hepatol Res. 2013;43(7):709-16. doi:10.1111/hepr.12016.

Hepatosellüler Karsinomalı Hastalarda Kan Nötrofil Lenfosit Oranı ile Tümör Boyutu, Tümör Sayısı ve Makrovasküler İnvazyon Arasındaki İlişki

Year 2019, Volume: 3 Issue: 3, 207 - 212, 26.10.2019
https://doi.org/10.30565/medalanya.551550

Abstract

Amaç: Hepatosellüler Karsinomu olan hastalarda tanı anındaki tümör boyutu, tümör sayısı ve makrovasküler invazyon ile kan nötrofil lenfosit oranı arasındaki ilişkiyi göstermeyi amaçladık. 

Hastalar ve Method: Çalışmaya toplam 48 hepatosellüler karsinomalı hasta dahil edildi. Hastalar ortalama nötrofil lenfosit oranına göre ikiye bölündü. 

Bulgular: Toplam 48 hastanın 11’i kadın, 37’si erkek idi. Hastaların ortalama yaşı 67,18±9,51 idi. Ortalama nötrofil lenfosit oranı 3,17 idi. Nötrofil lenfosit oranı (NLR)>3,17 olan hastalarda makrovasküler invazyon, tümör sayısının>3, tümör boyutu>5 cm, Child-Turcot-Pugh skor, Model for End-stage Liver Disease- Sodyum skor, C-reaktif protein and kan sodyum seviyesi ile arasında istatistiksel olarak anlamlı birliktelik izlendi (p: 0.005, p: 0.009, p< 0.001, p: 0.003, p:0.008, p: 0.035 ve p < 0.001, sırasıyla). Multiple lojistik lineer regresyon analizİ; hepatosellüler karsinomlu hastalarda NLR> 3.17 olması tumor boyutu> 5 cm and hiponatreminin bağımsız bir belirteci olduğunu gösterdi (p: 0.010, p: 0.012, sırasıyla). 

Sonuç: Hepatosellüler karsinomalı hastalarda tanı anındaki kan nötrofil lenfosit oranının değeri, tümör boyutunun ve hastalık evresinin iyi bir belirtecidir. 

References

  • 1. Bosch FX, Ribes J, Cleries R, Diaz M. Epidemiology of hepatocellular carcinoma. Clin Liver Dis. 2005;9:191-211. doi: 10.1016/j.cld.2004.12.009.
  • 2. Forner A, Reig ME, de Lope CR, Bruix J. Current strategy for staging and treatment: the BCLC update and future prospects. Semin Liver Dis. 2010;30:61–74. doi: 10.1055/s-0030-1247133.
  • 3. Yao FY, Ferrell L, Bass NM, Watson JJ, Bacchetti P, Venook A, et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatol. 2001;33:1394-403. doi:10.1053/jhep.2001.24563.
  • 4. Tsochatzis EA, Germani G, Burroughs AK. Transarterial chemoembolization, transarterial chemotherapy, and intra-arterial chemotherapy for hepatocellular carcinoma treatment. Semin Oncol. 2010;37:89-93. doi: 10.1053/j.seminoncol. 2010.03.007.
  • 5. Duvoux C, Roudot-Thoraval F, Decaens T, Pessione F, Badran H, Piardi T, et al. Liver transplantation for hepatocellular carcinoma: a model including alpha-fetoprotein improves the performance of Milan criteria. Gastroenterol. 2012;143:986-94e3. doi: 10.1053/j.gastro.2012.05.052.
  • 6. Koh CH, Bhoo-Pathy N, Ng KL, Jabir RS, Tan GH, See MH, et al. Utility of pre-treatment neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as prognostic factors in breast cancer. Brit J Cancer. 2015;113:150-8. doi: 10.1038/bjc.2015.183.
  • 7. Aliustaoglu M, Bilici A, Ustaalioglu BB, Konya V, Gucun M, Seker M, et al. The effect of peripheral blood values on prognosis of patients with locally advanced gastric cancer before treatment. Med Oncol. 2010;27:1060-5. doi: 10.1007/s12032-009-9335-4.
  • 8. Xu ZG, Ye CJ, Liu LX, Wu G, Zhao ZX, Wang YZ, et al. 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(2):189-99. doi: 10.2217/bmm-2017-0307.
  • 9. Liu C, Jia BS, Zou BW, Du H, Yan LN, Yang JY, et al. Neutrophil-to-lymphocyte and aspartate-to-alanine aminotransferase ratios predict hepatocellular carcinoma prognosis after transarterial embolization. Medicine (Baltimore). 2017;96(45):e8512. doi: 10.1097/MD.0000000000008512.
  • 10. Jordi Bruix, Morris Sherman. Management of Hepatocellular Carcinoma: An Update. Hepatology. 2011;53(3):1020-2. doi: 10.1002/hep.24199.
  • 11. Freeman RB Jr, Wiesner RH, Harper A, McDiarmid SV, Lake J, Edwards E. The new liver allocation system: moving toward evidence-based transplantation policy. Liver Transpl 2002;8:851-8. doi: 10.1053/jlts.2002.35927.
  • 12. Pang Q, Zhou L, Qu K, Cui RX, Jin H, Liu HC. Validation of inflammation-based prognostic models in patients with hepatitis B-associated hepatocellular carcinoma: a retrospective observational study. Eur J Gastroenterol Hepatol. 2018;30(1):60-70. doi: 10.1097/MEG.0000000000001021.
  • 13. Zheng J, Cai J, Li H, Zeng K, He L, Fu H, et al. Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio as Prognostic Predictors for Hepatocellular Carcinoma Patients with Various Treatments: a Meta-Analysis and Systematic Review. Cell Physiol Biochem. 2017;44(3):967-81. doi: 10.1159/000485396.
  • 14. He CB, Lin XJ. Inflammation scores predict the survival of patients with hepatocellular carcinoma who were treated with transarterial chemoembolization and recombinant human type-5 adenovirus H101. 2017;12(3):e0174769. doi: 10.1371/journal.pone.0174769.
  • 15. Tandon P, Garcia-Tsao G. Prognostic indicators in hepatocellular carcinoma: a systematic review of 72 studies. Liver Int. 2009;29:502–10. doi: 10.1111/j.1478-3231.2008.01957.x.
  • 16. Giuseppe M, Silvana E, Ascanio M, Antonio G, Vincenza A, Anna P, et al. A new prognostic system for hepatocellular carcinoma: a retrospective study of 435 patients: the Cancer of the Liver Italian Program (CLIP) investigators. Hepatol. 1998;28:751–5. doi: 10.1002/hep.510280322.
  • 17. Yau T, Tang VY, Yao TJ, Fan ST, Lo CM, Poon RT. Development of Hong Kong Liver Cancer staging system with treatment stratification for patients with hepatocellular carcinoma. Gastroenterol. 2014;146:1691–1700. doi: 10.1053/j.gastro.2014.02.032.
  • 18. Kudo M, Chung H, Osaki Y. Prognostic staging system for hepatocellular carcinoma (CLIP score): its value and limitations, and a proposal for a new staging system, the Japan Integrated Staging Score (JIS score) J Gastroenterol. 2003;38:207–15. doi: 10.1007/s005350300038.
  • 19. Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and cancer. Cell. 2010;140:883-99. doi: 10.1016/j.cell.2010.01.025.
  • 20. Wu Y, Zhao Q, Peng C, Sun L, Li XF, Kuang DM. Neutrophils promote motility of cancer cells via a hyaluronan-mediated TLR4/PI3K activation loop. J Pathol. 2011;225:438-47. doi: 10.1002/path.2947.
  • 21. Jablonska J, Leschner S, Westphal K, Lienenklaus S, Weiss S. Neutrophils responsive to endogenous IFN-beta regulate tumor angiogenesis and growth in a mouse tumor model. J Clin Invest. 2010;120:1151–64. doi: 10.1172/JCI37223.
  • 22. Nind AP, Nairn RC, Rolland JM, Guli EP, Hughes ES. Lymphocyte anergy in patients with carcinoma. Br J Cancer. 1973;28:108–17. PMC2008880
  • 23. Wang Q, Blank S, Fiel MI, Kadri H, Luan W, Warren L, et al. The Severity of Liver Fibrosis Influences the Prognostic Value of Inflammation-Based Scores in Hepatitis B-Associated Hepatocellular Carcinoma. Ann Surg Oncol. 2015;22Suppl 3:S1125-32. doi: 10.1245/s10434-015-4598-9.
  • 24. Oh BS, Jang JW, Kwon JH, You CR, Chung KW, Kay CS, et al. Prognostic value of C-reactive protein and neutrophil-to-lymphocyte ratio in patients with hepatocellular carcinoma. BMC Cancer. 2013;13:78. doi: 10.1186/1471-2407-13-78.
  • 25. Yoshizumi T, Ikegami T, Yoshiya S, Motomura T, Mano Y, Muto J, et al. Impact of tumor size, number of tumors and neutrophil-to-lymphocyte ratio in liver transplantation for recurrent hepatocellular carcinoma. Hepatol Res. 2013;43(7):709-16. doi:10.1111/hepr.12016.
There are 25 citations in total.

Details

Primary Language English
Subjects ​Internal Diseases
Journal Section Research Article
Authors

Özlem Özer Çakır 0000-0002-5916-8049

Publication Date October 26, 2019
Submission Date April 9, 2019
Acceptance Date October 19, 2019
Published in Issue Year 2019 Volume: 3 Issue: 3

Cite

Vancouver Özer Çakır Ö. The Relationship Between Blood Neutrophil to Lymphocyte Ratio and Tumor Size, Tumor Number, Macrovascular Invasion in Patients with Hepatocellular Carcinoma. Acta Med. Alanya. 2019;3(3):207-12.

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