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White DL, Thrift AP, Kanwal F, Davila J, El-Serag HB. Incidence of hepatocellular carcinoma in all 50 United States, from 2000 through 2012. Gastroenterology 2017; 152: 812-820, e5.

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Article

Neutrophil to Lymphocyte Ratio as Predictive Marker of Recurrence of HCC after Radiofrequency Ablation

1Department of internal medicine, faculty of Medicine (Girls), Al Azher University, Cairo, Egypt

2Department of gastroenterology and Hepatology, Theodor Bilharz Research Institute, Cairo, Egypt


American Journal of Clinical Medicine Research. 2019, Vol. 7 No. 1, 1-8
DOI: 10.12691/ajcmr-7-1-1
Copyright © 2019 Science and Education Publishing

Cite this paper:
Eman M. Abdel Rahman, Fatma M. EL-Senosy, Ayman Alsebaey, Shiamaa A. Hussien. Neutrophil to Lymphocyte Ratio as Predictive Marker of Recurrence of HCC after Radiofrequency Ablation. American Journal of Clinical Medicine Research. 2019; 7(1):1-8. doi: 10.12691/ajcmr-7-1-1.

Correspondence to: Fatma  M. EL-Senosy, Department of internal medicine, faculty of Medicine (Girls), Al Azher University, Cairo, Egypt. Email: fat_sen@yahoo.com

Abstract

Background: Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and prognostic nutritional index (PNI), are immunonutritional indices, have been shown as an independent factor to predict postoperative recurrence and/or overall survival in patients with hepatocellular carcinoma (HCC). Aim: to validate neutrophils-to-lymphocytes ratio (NLR) as a predictor of post radiofrequency ablation recurrence of hepatocellular carcinoma (HCC). Patients and methods: This cross sectional prospective study was conducted on 50 Egyptian patients had radiofrequency ablation for HCC within Barcelona clinical liver cancer (BCLC) stage A. Pre-treatment laboratory tests and imaging were used to measure NLR, PLR, PNI, Child-Pugh (CTP score, tumor number and tumor size. HCC recurrences were followed after three month. Results: According to NLR cut-off value, the patients with NLR >1.73 had larger tumour size, and higher rates of tumor multiplicity .After 3 month follow up 30/50 (60%) patients had tumour recurrence. Regarding recurrence after RFA showed that CTP class B (P<0.05), tumor size (P<0.05), higher rates of tumor multiplicity (P<0.05), decrease PNI (P<0.001) and increased NLR (P<0.05) after RFA and at baseline were found to be worse prognosis. A receiver-operating characteristic (ROC) analysis was used to classify patients as follows: NLR-PNI 0 group (NLR≤1.73 and PNI > 11.74), NLR-PNI 1 group (NLR > 1.73 or PNI ≤ 11.74) and NLR-PNI 2 group (NLR > 1.73 and PNI ≤ 11.74). The patients with NLR-PNI 2 group had increase in number of portahepatis lymph node, number and size of tumor, decrease serum albumin and change in PNLR. Multivariate analyses suggested increased NLR (hazard ratio [HR] =2.09; 95% confidence interval [CI] =1.88–2.55; P<0.05), increased PLR (HR=0.07; 95% CI=0.06–0.08; P<0.05), and increased AFP (HR=59.20; 95% CI=-99.74–638.78; P<0.05) contributed to post-RFA mortality. Conclusion: High blood NLR after RFA is a predictor for worse survival and also can predict recurrence of HCC. Higher NLR-PNI score predict a worse prognosis in patients who underwent RFA.

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