The preoperative neutrophil-to-lymphocyte ratio predicts the outcomes of patients with hepatocellular carcinoma and cirrhosis after hepatectomy

Objective The aim of the study was to investigate the prognostic value of the preoperative peripheral neutrophil-to-lymphocyte ratio （NLR） in patients with hepatocellular cancer （HCC） and cirrhosis after hepa- tectomy. Methods This retrospective study included 321 patients with HCC who underwent resection. The NLR was calculated using the neutrophil and lymphocyte counts in routine preoperative blood tests. Receiver operating characteristic curve analysis was performed to select the most appropriate NLR cutoff value. The preoperative NLR, patient demographics, and clinical and pathological data, including disease-free survival （DFS） and overall survival （OS）, were analyzed. Results The NLR was correlated with alpha-fetoprotein levels （X2 = 5.876, P = 0.015）, tumor size （X2 = 32.046, P 〈 0.001）, portal vein tumor thrombus （PVTT; x2 = 4.930, P = 0.026）, tumor encapsulation （x2 = 7.243, P = 0.007）, and recurrence （x2 = 7.717, P = 0.005）. Multivariate analyses illustrated that the number of tumors, PVTT, tumor size, and the NLR were independent factors for predicting DFS and OS. in patients with HCC and cirrhosis, but not among those without cirrhosis, a larger NLR predicted poorer postoperative DFS and OS （both P 〈 0.001）. Conclusion As a simple, effective independent predictor for patients with HCC, the preoperative NLR plays an important role in accurately predicting the postoperative outcomes of patients with HCC and cir- rhosis, but not those of patients without cirrhosis.

Comparison of clinical efficacy between LAPS and ALPPS in the treatment of hepatitis B virus-related hepatocellular carcinoma

Background:Insufficient post-operative future liver remnant(FLR)limits the feasibility of hepatectomy for patients.Staged hepatectomy is an effective surgical approach that can improve the resection rate of hepatocellular carcinoma(HCC).This study aimed to compare the safety and efficacy of laparoscopic microwave ablation and portal vein ligation for staged hepatectomy(LAPS)and classical associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)in the treatment of hepatitis B virus(HBV)-related HCC.Methods:Clinical data of patients with HBV-related HCC who underwent LAPS or ALPPS in our institute between January 2017 and May 2022 were retrospectively analysed.Results:A total of 18 patients with HBV-related HCC were retrospectively analysed and divided into the LAPS group(n=9)and ALPPS group(n=9).Eight patients in the LAPS group and eight patients in the ALPPS group proceeded to a similar resection rate(88.9%vs 88.9%,P=1.000).The patients undergoing LAPS had a lower total comprehensive complication index than those undergoing ALPPS but there was not a significant different between the two groups(8.66 vs 35.87,P=0.054).The hypertrophy rate of FLR induced by ALPPS tended to be more rapid than that induced by LAPS(24.29 vs 13.17 mL/d,P=0.095).The 2-year recurrence-free survival(RFS)was 0%for ALPPS and 35.7%for LAPS(P=0.009),whereas the 2-year overall survival for ALPPS and LAPS was 33.3%and 100.0%(P=0.052),respectively.Conclusions:LAPS tended to induce lower morbidity and FLR hypertrophy more slowly than ALPPS,with a comparable resection rate and better long-term RFS in HBV-related HCC patients.