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Utility of Inflammatory Markers in Predicting Hepatocellular Carcinoma Survival after Liver Transplantation

Inflammatory markers have been studied in cancers and chronic states of inflammation. They are thought to correlate with tumor pathology through disruption of normal homeostasis. Markers such as neutrophil to lymphocyte ratio (NLR) among others have shown promise as prognostic tools in various cance...

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Autores principales: Ismael, Media N., Forde, Justin, Milla, Eduardo, Khan, Walid, Cabrera, Roniel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6817919/
https://www.ncbi.nlm.nih.gov/pubmed/31737675
http://dx.doi.org/10.1155/2019/7284040
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author Ismael, Media N.
Forde, Justin
Milla, Eduardo
Khan, Walid
Cabrera, Roniel
author_facet Ismael, Media N.
Forde, Justin
Milla, Eduardo
Khan, Walid
Cabrera, Roniel
author_sort Ismael, Media N.
collection PubMed
description Inflammatory markers have been studied in cancers and chronic states of inflammation. They are thought to correlate with tumor pathology through disruption of normal homeostasis. Markers such as neutrophil to lymphocyte ratio (NLR) among others have shown promise as prognostic tools in various cancers. In this study, we evaluate complete blood count based inflammatory markers in hepatocellular carcinoma (HCC) to predict overall and recurrence-free survival of patients after liver transplant. Between 2001 and 2017, all HCC indicated liver transplants were retrospectively reviewed. Inclusion criteria included presence of complete blood cell counts with differential within three months prior to transplantation. Exclusion criteria included retransplantation and inadequate posttransplant followup. A total of 160 patients with HCC were included in the study. Of those, 74.4% had hepatitis C virus as the underlying cause of HCC. Calculated Model for End stage Liver Disease (MELD) scores were statistically worse in patients with elevated NLR (≥5), derived NLR (≥3), and low lymphocyte to monocyte ratio (LMR) (<3.45), whereas elevated platelet to lymphocyte ratio (PLR) (≥150) did not correlate with MELD. Of the tumor characteristics, low LMR was associated with tumor presence and microvascular invasion on explant. Though overall survival trended towards better outcomes with low NLR and dNLR and high LMR, these did not reach statistical significance. High LMR also trended towards better recurrence-free survival without statistical significance. Low PLR was associated with statistically significant overall and recurrence-free survival. In conclusion, while prior studies in HCC have identified NLR as surrogate for tumor burden and survival, in this study we highlight that PLR is a good surrogate of mortality and recurrence-free survival in HCC transplant patients. Further, future study of PLR, NLR, and LMR in larger HCC populations before and after interventions may help clarify their clinical utility as a simple and noninvasive clinical tool as prognostic markers.
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spelling pubmed-68179192019-11-17 Utility of Inflammatory Markers in Predicting Hepatocellular Carcinoma Survival after Liver Transplantation Ismael, Media N. Forde, Justin Milla, Eduardo Khan, Walid Cabrera, Roniel Biomed Res Int Research Article Inflammatory markers have been studied in cancers and chronic states of inflammation. They are thought to correlate with tumor pathology through disruption of normal homeostasis. Markers such as neutrophil to lymphocyte ratio (NLR) among others have shown promise as prognostic tools in various cancers. In this study, we evaluate complete blood count based inflammatory markers in hepatocellular carcinoma (HCC) to predict overall and recurrence-free survival of patients after liver transplant. Between 2001 and 2017, all HCC indicated liver transplants were retrospectively reviewed. Inclusion criteria included presence of complete blood cell counts with differential within three months prior to transplantation. Exclusion criteria included retransplantation and inadequate posttransplant followup. A total of 160 patients with HCC were included in the study. Of those, 74.4% had hepatitis C virus as the underlying cause of HCC. Calculated Model for End stage Liver Disease (MELD) scores were statistically worse in patients with elevated NLR (≥5), derived NLR (≥3), and low lymphocyte to monocyte ratio (LMR) (<3.45), whereas elevated platelet to lymphocyte ratio (PLR) (≥150) did not correlate with MELD. Of the tumor characteristics, low LMR was associated with tumor presence and microvascular invasion on explant. Though overall survival trended towards better outcomes with low NLR and dNLR and high LMR, these did not reach statistical significance. High LMR also trended towards better recurrence-free survival without statistical significance. Low PLR was associated with statistically significant overall and recurrence-free survival. In conclusion, while prior studies in HCC have identified NLR as surrogate for tumor burden and survival, in this study we highlight that PLR is a good surrogate of mortality and recurrence-free survival in HCC transplant patients. Further, future study of PLR, NLR, and LMR in larger HCC populations before and after interventions may help clarify their clinical utility as a simple and noninvasive clinical tool as prognostic markers. Hindawi 2019-10-14 /pmc/articles/PMC6817919/ /pubmed/31737675 http://dx.doi.org/10.1155/2019/7284040 Text en Copyright © 2019 Media N. Ismael et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Ismael, Media N.
Forde, Justin
Milla, Eduardo
Khan, Walid
Cabrera, Roniel
Utility of Inflammatory Markers in Predicting Hepatocellular Carcinoma Survival after Liver Transplantation
title Utility of Inflammatory Markers in Predicting Hepatocellular Carcinoma Survival after Liver Transplantation
title_full Utility of Inflammatory Markers in Predicting Hepatocellular Carcinoma Survival after Liver Transplantation
title_fullStr Utility of Inflammatory Markers in Predicting Hepatocellular Carcinoma Survival after Liver Transplantation
title_full_unstemmed Utility of Inflammatory Markers in Predicting Hepatocellular Carcinoma Survival after Liver Transplantation
title_short Utility of Inflammatory Markers in Predicting Hepatocellular Carcinoma Survival after Liver Transplantation
title_sort utility of inflammatory markers in predicting hepatocellular carcinoma survival after liver transplantation
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6817919/
https://www.ncbi.nlm.nih.gov/pubmed/31737675
http://dx.doi.org/10.1155/2019/7284040
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