Prognostic Value of NLR and PLR in Hepatocellular Carcinoma After Liver Resection or Transplanta

28 Apr 20265 min read0 viewsJournal Feed

GIST

BackgroundSystemic 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).MethodsIn 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.ResultsElevated 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.

Clinical Editorial

Study objective and rationale

This retrospective multicenter analysis evaluated whether peripheral inflammation markers—neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR)—are associated with overall survival (OS) and recurrence-free survival (RFS) in patients with hepatocellular carcinoma (HCC) undergoing curative-intent liver resection (hepatectomy) or orthotopic liver transplantation (OLT).

The authors framed the work on the premise that systemic inflammation influences HCC biology and postoperative outcomes.

Design, cohort, and measurements

The cohort comprised 74 patients (majority male; median age reported) treated across multiple centers.

NLR and PLR were measured preoperatively and at 1, 3, 6, and 12 months after surgery.

Statistical approaches included univariate and multivariable analyses, Cox proportional hazards models incorporating time-varying covariates, and model discrimination quantified by Harrell’s concordance (C) index.

Major postoperative complications were evaluated against preoperative biomarker levels using AUROC.

Key findings—prognostic performance

Elevated preoperative PLR was associated with a higher risk of major postoperative complications (AUROC 0.667, p = 0.030).
The 3-month postoperative NLR showed strong discrimination for OS (C-index 0.79).
Time-varying Cox models identified postoperative NLR as a statistically significant, time-independent predictor of OS (hazard ratio reported, p = 0.033), with this effect independent of surgical procedure and BCLC stage.
Multivariable models indicated that higher NLR at 3, 6, and 12 months, and higher PLR at 12 months, independently predicted worse OS.
Hepatectomy (versus OLT) was the principal factor associated with reduced RFS.

Subgroup signal and thresholds

The authors report that an NLR threshold above 2.5 delineated a subgroup with substantially increased mortality risk, particularly among patients treated with hepatectomy.