Preoperative plus postoperative neutrophil-lymphocyte ratio for predicting overall survival following partial hepatectomy for hepatocellular carcinoma

The preoperative neutrophil-lymphocyte ratio (NLR) and the postoperative NLR have been reported to be prognostic factors for malignant tumors. However, the prognostic value of combining the preoperative NLR and postoperative NLR for hepatocellular carcinoma (HCC) remains unclear. In the present study, a cohort of 70 patients with primary HCC were retrospectively reviewed. The optimal cut-offs for continuous variables were determined by the maximally selected rank statistics. The prognostic factors included preoperative NLR, postoperative NLR, preoperative NLR plus postoperative NLR, change in postoperative NLR, and postoperative NLR minus preoperative NLR. The predictive powers of the aforementioned prognostic factors were analyzed by the area under the time-dependent receiver operating characteristic (td-AUC) curve. Prognostic values were assessed by univariate and multivariate analyses. An increased preoperative NLR was found to be associated with higher preoperative neutrophil levels, lower preoperative lymphocyte levels and larger tumor sizes (all P<0.05). An increased postoperative NLR was associated with higher postoperative neutrophil levels and lower postoperative lymphocyte levels (all P<0.05). Multivariate analysis identified the preoperative NLR plus postoperative NLR as an independent prognostic risk factor (HR, 2.985; 95% CI, 1.648–5.407; P<0.001). The preoperative NLR plus postoperative NLR had higher td-AUC values than the preoperative NLR, postoperative NLR, postoperative NLR change, and postoperative NLR minus the preoperative NLR in the first to fourth years after surgery. The preoperative NLR plus postoperative NLR, considering both the preoperative and postoperative treatment phases, is a novel and promising prognostic factor for patients with HCC and requires further investigation in the future.