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13 January 2020 : Clinical Research  

The Prognostic Role of a Combined Fibrinogen and Neutrophil-to-Lymphocyte Ratio Score in Patients with Resectable Hepatocellular Carcinoma: A Retrospective Study

Weihao Kong12ACE, Honghai Xu34CDE, Jiongjiong Cheng12CDF, Zheng Fang12CF, Hengyi Wang12AG, Jian Zhang5ABE*, Xingyu Wang12CEG, Tianxing Dai5BCD, Yufeng Gao36ADEF

DOI: 10.12659/MSM.918824

Med Sci Monit 2020; 26:e918824


BACKGROUND: Inflammation and activation of the coagulation cascades have a role in the pathogenesis of malignancy, including hepatocellular carcinoma (HCC). This retrospective study aimed to investigate the prognostic role of the combined fibrinogen and neutrophil-to-lymphocyte ratio (F-NLR) in patients with resectable HCC.

MATERIAL AND METHODS: This retrospective study included 292 patients with HCC who underwent surgical resection. The receiver operating characteristic (ROC) curve was used to determine the cut-off value of preoperative fibrinogen (Fib) levels and the neutrophil-to-lymphocyte ratio (NLR). The. Hyperfibrinogenemia was >3.35 g/L, and an increased NLR was ≥2.47. The F-NLR was calculated for all patients. Kaplan-Meier survival curves, univariate analysis, multivariate analysis, and subgroup analysis were used to identify independent prognostic factors for overall survival (OS) and disease-free survival (DFS). The receiver operating characteristic (ROC) curve analysis of the F-NLR score and OS, according to the Barcelona Clinic Liver Cancer (BCLC) stage, was performed.

RESULTS: Increased F-NLR scores were significantly associated with the presence of tumor thrombus (P=0.001), larger tumor diameter (P<0.001), vascular invasion (P<0.001), and increased BCLC stage (P<0.001). Multivariate analysis showed that the F-NLR score was an independent predictor of OS (P<0.001) and DFS (P=0.002). The prognostic role of F-NLR was significant for BCLC stage 0–I (P=0.004; P<0.001) and BCLC stage II–III (P=0.026; P=0.005) for OS and DFS, respectively.

CONCLUSIONS: In patients with resectable HCC, the combined F-NLR score, a new indicator of systemic inflammation, was an independent prognostic indicator.

Keywords: Carcinoma, Hepatocellular, Fibrinogen, Neutrophils, Disease-Free Survival, Liver Neoplasms, Lymphocytes, Multivariate Analysis, ROC Curve

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750