Analysis of Factors Affecting Recurrence of Hepatocellular Carcinoma After Liver Transplantation With a Special Focus on Inflammation Markers

Background. Systemic inflammation markers, such as neutrophil-to-lymphocyte ratio (NLR), have recently emerged as the prognostic factors for recurrence of liver tumors. Methods. We assessed the ability of NLR and of other variables to predict the outcomes of orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC). A retrospective analysis was performed in 219 patients with HCC who underwent OLT between 1997 and 2009, with a median follow-up of 40 months. Results. Overall 3- and 5-year patient survival rates were 76.6% and 70.7%, respectively. Overall 3- and 5-year recurrence-free survival (RFS) rates were 83.8% and 82.1%, respectively. On univariate analysis, the factors affecting overall survival were alpha-fetoprotein more than 30 ng/mL (P = 0.006), NLR more than or equal to 5 (P < 0.0001), hepatitis C infection (P = 0.043), and presence of microvascular invasion (MVI; P = 0.006). Preoperative treatments (P = 0.006), alpha-fetoprotein more than 30 ng/mL (P = 0.003), NLR more than or equal to 5 (P < 0.0001), exceeding Milan criteria at final histology (P = 0.001), poor tumor differentiation (P = 0.02), and presence of MVI (P < 0.0001) predicted a lower RFS. Cox's proportional hazard model showed that only increased NLR and presence of MVI independently predicted overall survival and RFS. Conclusions. NLR is an important predictor of outcome after OLT for HCC and should be used to identify OLT candidates at high risk of recurrence.