Korean J Transplant.  2020 Jun;34(2):92-99. 10.4285/kjt.2020.34.2.92.

Preoperative blood neutrophil count predicts survival in hepatocellular carcinoma patients with living donor liver transplantation

Affiliations
  • 1Department of Internal Medicine, Pusan National University School of Medicine, Liver center, Pusan National University Yangsan Hospital, Yangsan, Korea
  • 2Department of Surgery, Pusan National University School of Medicine, Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Pusan National University Yangsan Hospital, Yangsan, Korea
  • 3Department of Pharmacology, Pusan National University School of Medicine, Yangsan, Korea

Abstract

Background
The Milan criteria (MC) used to select patients for liver transplantation among patients with hepatocellular carcinoma (HCC) do not include tumor biology. Furthermore, systemic inflammatory markers have been identified to predict tumor biology. The present study investigated prognostic value of systemic inflammatory markers, including neutrophil count, in predicting the prognosis of patients with HCC undergoing living donor liver transplantation (LDLT).
Methods
We retrospectively analyzed data regarding peripheral blood inflammatory markers, as well as patient and tumor characteristics of patients with HCC who underwent LDLT. Univariate and multivariate analyses were performed to analyze variables associated with survival.
Results
A total of 103 patients with HCC who underwent LDLT were included. The 3- and 5-year recurrence-free survival (RFS) in patients with a high neutrophil count (>2,640/μL) were significantly lower than those in patients with a low neutrophil count (≤2,640/μL; 70.0% and 64.7% vs. 88.3% and 84.6%, respectively; P=0.02). Patients with a high neutrophil count also had lower 5-year overall survival (OS; 63.9% vs. 79.3%, P=0.03). In multivariate analysis, radiologic MC (hazard ratio [HR], 5.04; P=0.02) and neutrophil count (HR, 4.47; P=0.04) were independent factors predicting RFS. Among patients exceeding the MC, those with a high neutrophil count had significantly lower 5-year RFS than those with low neutrophil count (10% vs. 83%; P<0.01).
Conclusions
We demonstrated that high preoperative neutrophil count is associated with poor RFS and OS in patients with HCC undergoing LDLT.

Keyword

Milan criteria; Prognosis; Recurrence-free survival; Neutrophil; Protein induced by vitamin K absence-II
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