Frontiers in immunology · 2026
Prognostic significance of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in hepatocellular carcinoma: a retrospective multicenter study on overall and recurrence-free survival following liver resection or liver transplantation.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Arvanitakis Konstantinos, Pantzios Spyridon, Christou Chrysanthos, Papadopoulos Vasileios, Theocharidou Eleni, Topalidis Christos, Kalopitas Georgios, Sidiropoulos Orestis, Chatzigeorgiou Antonios, Mitroulis Ioannis, Koletsa Triantafyllia, Hytiroglou Prodromos, Katsanos Georgios, Elefsiniotis Ioannis, Tsoulfas Georgios, Germanidis Georgios
Аннотация
BACKGROUND: Systemic inflammation plays a critical role in hepatocellular carcinoma (HCC) progression and postoperative outcomes. This study assessed the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) for overall (OS) and recurrence-free survival (RFS) in patients undergoing curative hepatectomy or orthotopic liver transplantation (OLT).
METHODS: In this multicenter retrospective cohort of 74 HCC patients (86.5% male; median age 68.0 years), NLR and PLR were evaluated preoperatively and at 1-, 3-, 6-, and 12-months post-surgery. Associations with OS and RFS were evaluated using univariate, multivariable, and Cox proportional hazards models with time-varying covariates, while model discrimination was assessed using Harrell's concordance index.
RESULTS: Elevated preoperative PLR predicted major postoperative complications (AUROC = 0.667, p = 0.030). The 3-month NLR demonstrated strong discriminative performance for OS (C-index 0.79). In time-varying Cox models, postoperative NLR emerged as a robust, time-independent predictor of OS (HR 1.35; p = 0.033), independent of the surgical procedure and Barcelona Clinic Liver Cancer stage. Multivariable analyses demonstrated that elevated NLR at 3-, 6-, and 12-months and PLR at 12 months independently predicted reduced OS. Hepatectomy was the dominant determinant of reduced RFS compared with OLT (p < 0.001), while an NLR threshold >2.5 identified a subgroup at markedly increased mortality risk, particularly following hepatectomy.
CONCLUSIONS: Postoperative NLR is a powerful, time-independent prognostic biomarker for OS in surgically treated HCC, especially after liver resection, while PLR provides complementary prognostic information. These findings support the clinical integration of inflammation-based biomarkers into postoperative risk stratification and surveillance strategies.
METHODS: In this multicenter retrospective cohort of 74 HCC patients (86.5% male; median age 68.0 years), NLR and PLR were evaluated preoperatively and at 1-, 3-, 6-, and 12-months post-surgery. Associations with OS and RFS were evaluated using univariate, multivariable, and Cox proportional hazards models with time-varying covariates, while model discrimination was assessed using Harrell's concordance index.
RESULTS: Elevated preoperative PLR predicted major postoperative complications (AUROC = 0.667, p = 0.030). The 3-month NLR demonstrated strong discriminative performance for OS (C-index 0.79). In time-varying Cox models, postoperative NLR emerged as a robust, time-independent predictor of OS (HR 1.35; p = 0.033), independent of the surgical procedure and Barcelona Clinic Liver Cancer stage. Multivariable analyses demonstrated that elevated NLR at 3-, 6-, and 12-months and PLR at 12 months independently predicted reduced OS. Hepatectomy was the dominant determinant of reduced RFS compared with OLT (p < 0.001), while an NLR threshold >2.5 identified a subgroup at markedly increased mortality risk, particularly following hepatectomy.
CONCLUSIONS: Postoperative NLR is a powerful, time-independent prognostic biomarker for OS in surgically treated HCC, especially after liver resection, while PLR provides complementary prognostic information. These findings support the clinical integration of inflammation-based biomarkers into postoperative risk stratification and surveillance strategies.