Preoperative inflammatory markers prognostic indicators after liver resection

BRAZIL: In western patients who have undergone liver resection for tumors, preoperative inflammatory markers are beneficial for predicting long-term prognosis, states research published in BMC Surgery.

With more than 900,000 fatalities yearly from cancer-related causes, hepatocellular carcinoma (HCC) is the third most common cause of cancer-associated mortality globally. Serum alpha-fetoprotein levels, the number of lesions, the tumor size, the evidence of vascular invasion, and satellite nodules are the primary prognostic variables for patients with HCC who had a resection. The majority of these criteria, unfortunately, cannot be employed to choose preoperative patients and must be evaluated following surgical specimen analysis.

"Recent research from eastern centers has shown a link between the inflammatory response and long-term results following the removal of hepatocellular carcinoma (HCC). Yet, it is still unclear how inflammatory indicators may affect prognosis in western patients with diverse tumor and epidemiologic traits," the authors said.

The researchers aimed to assess the prognostic significance of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), as well as their relevance with tumor size (5 cm, 5-10 cm, > 10 cm), in people treated with HCC resection with curative intent.

For this objective, consecutive adult patients with pathologically confirmed HCC who had liver resection with curative intent from January 2007 to December 2018 were assessed using a prospective database. There were 161 consecutive adult patients in total. Clinical evaluations and liver function testing were performed on all individuals. Thoracic CT and abdominal helicoidal computed tomography (CT) or magnetic resonance imaging (MRI) were both performed before surgery. Age, gender, BMI, preoperative laboratory tests, cause of chronic liver disease, size and location of the lesions, the existence of cirrhosis, and portal hypertension were examined as preoperative variables. Within seven days of surgery, inflammatory indicators were assessed. The receiver operator curves were plotted to establish the ideal cut-off values for NLR, PLR, and MLR. The Kaplan-Meier method was used to compute the overall survival (OS) and disease-free survival (DFS) curves, and the log-rank test was used to compare them. The Cox method was applied to find independent predictors of OS and DFS.

Key highlights of the research:

• An elevated NLR (> 1.715) was linked to a lower overall survival (P = 0.018).
• Elevated NLR (> 2.475; P = 0.047) and PLR (> 100.25; P = 0.028) were predictive of short DFS.
• MLR (> 1.715) was linked to worse OS in HCC of <5 cm (P = 0.047).
• In the multivariate analysis, increased PLR was a significant independent predictor of worse DFS (hazard ratio (HR) 3.029; 95% CI 1.499-6.121; P = 0.002).

"Inflammatory indices are promising tools for identifying individuals before surgery who need stringent postoperative monitoring or may be candidates for innovative adjuvant treatment protocols," asserted the researchers.

While a high preoperative PLR is an independent factor linked with short DFS, an elevated preoperative NLR is associated with short OS and DFS. A high MLR is linked to a reduced OS in the subset of individuals with HCC that is less than 5 cm, concluded the authors.

REFERENCE

Silva, J.P.M., Coelho, F.F., Cassenote, A.J.F., et al. Preoperative inflammatory markers as prognostic predictors after hepatocellular carcinoma resection: data from a western referral center. BMC Surg 22, 329 (2022). https://doi.org/10.1186/s12893-022-01779-6