- 1Department of Medicine, University of California, San Francisco, USA.
- 2Division of Gastroenterology, Department of Medicine, University of California, San Francisco, USA.
- 3Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, USA.
Background: We assessed the prognostic significance and the clinical stability of NLR prior to LT in a large cohort of HCC patients from a long wait time region. A high preoperative neutrophil-to-lymphocyte (NLR) ≥ 5 has been reported to predict poor outcomes following liver transplantation (LT) for HCC, and NLR has been incorporated into several prognostic models.
Methods: We evaluated 758 HCC patients listed for LT with MELD exception from 2002-2015 at a single LT center, of which 505 underwent and 253 dropped out prior to LT. NLR was collected in all patients at LT and, if available, between 15-90 days prior to LT (NLR 2) or at dropout.
Results: NLR ≥ 5 was associated with microvascular invasion, poorer tumor differentiation, and more advanced pathology on explant. Patients with NLR ≥ 5 exhibited no differences in AFP, tumor burden at listing, or number of LRT compared to patients with NLR < 5. After a median post-LT follow-up of 4.7 years, overall survival and recurrence rates were similar for NLR ≥ 5 vs NLR < 5. The NLR changed frequently, and 47% of patients whose NLR2 was ≥ 5 had an NLR < 5 by LT. NLR was ≥ 5 in 47.6% of patients at dropout, compared with 14.9% of patients undergoing LT.
Conclusions: While NLR at LT correlated with MVI and tumor stage at explant, NLR did not predict post-LT survival or HCC recurrence. NLR appeared to be a relatively unstable inflammatory marker over the immediate three months prior to LT for HCC.