PD-L1(+)NEUT, Foxp3(+)Treg, and NLR as New Prognostic Marker with Low Survival Benefits Value in Hepatocellular Carcinoma

Background: This presented study was aimed to evaluate the diagnostic and prognostic value of PD-L1(+)Neutrophils (PD-L1(+)NEUT) and neutrophil to lymphocyte ratio (NLR) based on our previous experience of Foxp3(+)Treg in transplantation. Methods: the NLR cutoff value of 1.79 was used to include 136 cases from the 204 patients with hepatocellular carcinoma (HCC) confirmed by clinical pathology, which were divided into highly-moderately and poorly differentiated HCC groups. The expressions of PD-L1(+)NEUT and Foxp3(+)Treg in peripheral blood and cancer tissue were detected with flow cytometry, meanwhile, PD-L1 and Foxp3 expressed in carcinoma and para-carcinoma tissues were marked by immunohistochemistry. Survival rates, including overall survival and disease-free survival, were calculated by the Kaplan–Meier curve and evaluated with the log-rank test. Finally, Cox risk regression model was used to analyze the independent risk factors for prognostic survival. Results: The level of PD-L1(+)NEUT, Foxp3(+)Treg, and NLR in peripheral blood of patients with poorly differentiated HCC were significantly increased (all P < .001). Both PD-L1(+)NEUT and NLR were positively correlated with Foxp3(+)Treg (r = 0.479, P = .0017; r = 0.58, P < .0001). The level of PD-L1(+)NEUT and Foxp3(+)Treg as well as PD-L1 and Foxp3 in cancer tissue and patients with poorly differentiated HCC were obviously increased (all P < .01), respectively. Cox regression analysis indicated that PD-L1(+)NEUT, NLR, and Foxp3(+)Treg were independent risk factors for the prognosis (P = .000, .000, .006) with a RR and 95%CI of 2.704-(2.155-3.393), 3.139-(2.361-4.173), 1.409-(1.105-1.798), respectively. Conclusion: PD-L1(+)NEUT, NLR, and Foxp3(+)Treg are independent risk factors for prognosis which maybe new marker of lower survival benefits.