Peri-operative Inflammatory Markers Predict Prognosis Of Patients With Hepatocellular Carcinama After Liver Transplantation

BackgroundHepatocellular Carcinoma(HCC)is a common malignant tumor.More than 300,000 patients in China die of HCC every year,which seriously endangers the human health.Recently,studies suggest that inflammation is closely related to the occurrence and development of tumors.There are correlations between various inflammatory markers and the prognosis of patients with HCC after liver transplantation,including C-reactive protein(CRP)and Neutrophil lymphocyte ratio(NLR),Lymphocyte monocyte ratio(LMR),Platelet lymphocyte ratio(PLR),Systemic immune-inflammation index(SII),etc.The purpose of this study is to investigate the effects of peri-operative inflammatory markers on the prognosis of patients with HCC after liver transplantation,including overall survival and tumor-free survivalMethodsWe retrospectively collected clinical date of patients with HCC who underwent liver transplantation from January 2015 to December 2016 at the First Affiliated Hospital of Zhejiang University.The ROC curve and the Youden’s index were used to determine the optimal cut-off values of pre-transplant NLR,LMR,PLR,SII,post-transplant CRP peak and other risk factors affecting the prognosis of the transplant COX univariate analysis and multivariate analysis were used to finding the independent risk factors affecting postoperative survival,including overall survival and tumor-free survival.The OS IN model was constructed and combined with Hangzhou standard for postoperative prognosis analysis of patients with HCC liver transplantationResultsOf the 79 patients with HCC,median age was 52.8±8.67(30-69)years with a median post-transplant follow-up time was 25.02±13.94(1.33-46.87)months.The median recurrence time was 18.72±15.77(0.23-16.87)months.COX univariate and multivariate analysis showed that pre-transplant AFP,pre-transplant LPR and post-transplant CRP peak were independent risk factors for overall survival for HCC patients.Kaplan-Meier survival analysis showed that there was a significant difference of overall survival between the LMR≥1.18 group and the LMR<1.18 group(63.5%vs 18.8%,p<0.01),and between the post-transplant CRP peak<61.20 mg/L group and the post-transplant CRP peak>61.20 mg/L group.(88.2%vs 45.2%,p<0.01).Based on the above results,we defined the OS IN model,combined with the Hangzhou standard,divided 79 patients into 3 groups:Group 1:met the Hangzhou standard,a total of 39 cases;Group 2:did not meet the Hangzhou standard,but met the OS IN model,a total of 17 cases;group 3:did not meet the Hangzhou standard,nor the OS IN model,a total of 23 cases.Kaplan-Meier survival analysis showed no significant difference in overall survival between Group 1 and the Group 2(74.36%vs 64.79%,p=0.444);there was a significant difference of overall survival not only between Group 3 and Group 1,but also between Group 3 and Group 2(13.04%vs 74.36%,p<0.001;13.04%vs 64.79%,p=0.001).COX univariate and multivariate analysis showed that the peri-operative inflammatory markers involved in this study did not affect the postoperative tumor-free survival time of patients with HCC after liver transplantation.Conclusions1.Pre-transplant LMR and post-transplant CRP peak are independent risk factors affecting postoperative survival of HCC patients after liver transplantation.Declined pre-transplant LMR and elevated post-transplant CRP peak will significantly reduce post-operative survival.Than,the OS_IN model was constructed,and new inclusion opinions were proposed for liver transplant recipients beyond the Hangzhou standard.But,these conclusions need further verification.2.However,LNR,LPR,LMR,PLR before transplantation and post-transplant CRP peak have no predictive effect on post-operative tumor recurrence.