Preoperative white blood cell count predicts prognosis in patients with hepatocellular carcinoma beyond Milan criteria after hepatic resection

doi:10.16139/j.1007-9610.2018.04.017

Abstract

Abstract: Objective To study the prognostic value of preoperative white blood cell (WBC) count in patients with hepatocellular carcinoma(HCC) beyond Milan criteria after hepatic resection. Methods Clinical data of 237 patients with HCC beyond Milan criteria from Tianjin Medical University Cancer Hospital who underwent hepatectomy from June 2007 to December 2013 were retrospectively studied. The cut-off value of WBC count was determined by receiver operating characteristic curve, which was used to divide the patients in two groups. Survival curves were formed with Kaplan-Meier method and were analyzed using Log-Rank test. Cox proportional hazards model was developed to identify the risk factors of survival. Results WBC count 6.0 ×10⁹/L was the cut-off point between two groups. The median survival time of lower WBC count group and higher WBC count group were 53.4 and 27.6 months, respectively (P=0.002). The median recurrence-free survival of lower WBC count group and higher WBC count group were 20.7 and 12.2 months, respectively(P=0.029). The statistical differences in both survival time and recurrence-free survival remained between two groups after match analysis. Conclusions Preoperative WBC count might predict the prognosis of HCC patients beyond Milan criteria after hepatic resection.

Key words: Hepatocellular carcinoma, Milan criteria, Hepatectomy, White blood cell, Prognosis

CLC Number:

R735.7

HOU Zhenyu, KONG Yinlong, ZHANG Yongqiang, ZHU Keyun, YANG Xuejiao, CHEN Ping, LI Huikai, CUI Yunlong, SONG Tianqiang, LI Qiang, ZHANG Ti. Preoperative white blood cell count predicts prognosis in patients with hepatocellular carcinoma beyond Milan criteria after hepatic resection[J]. Journal of Surgery Concepts & Practice, 2018, 23(04): 358-362.

References

[1] Bruix J, Gores GJ, Mazzaferro V.Hepatocellular carcinoma: clinical frontiers and perspectives[J]. Gut,2014,63(5):844-855.
[2] Forner A, Llovet JM, Bruix J.Hepatocellular carcinoma[J]. Lancet,2012,379(9822):1245-1255.
[3] Bruix J, Sherman M, American Association for the Study of Liver Disease. Management of hepatocellular carcinoma: an update[J]. Hepatology,2011,53(3):1020-1022.
[4] European Association for the Study of the Liver, European Organisation for Research, Treatment of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma[J]. J Hepatol,2012,56(4):908-943.
[5] Zhong JH, Ke Y, Gong WF, et al.Hepatic resection associated with good survival for selected patients with intermediate and advanced-stage hepatocellular carcinoma[J]. Ann Surg,2014,260(2):329-340.
[6] Sakamoto K, Nagano H.Surgical treatment for advanced hepatocellular carcinoma with portal vein tumor thrombus[J]. Hepatol Res,2017,47(10):957-962.
[7] Torzilli G, Belghiti J, Kokudo N, et al.A snapshot of the effective indications and results of surgery for hepatocellular carcinoma in tertiary referral centers: is it adherent to the EASL/AASLD recommendations? an observational study of the HCC East-West study group[J]. Ann Surg,2013,257(5):929-937.
[8] Yang T, Lin C, Zhai J, et al.Surgical resection for advanced hepatocellular carcinoma according to Barcelona Clinic Liver Cancer (BCLC) staging[J]. J Cancer Res Clin Oncol,2012,138(7):1121-1129.
[9] Grimm RH Jr, Neaton JD, Ludwig W.Prognostic importance of the white blood cell count for coronary, cancer, and all-cause mortality[J]. JAMA,1985,254(14):1932-1937.
[10] Shankar A, Wang JJ, Rochtchina E, et al.Association between circulating white blood cell count and cancer mortality: a population-based cohort study[J]. Arch Intern Med,2006,166(2):188-194.
[11] Erlinger TP, Muntner P, Helzlsouer KJ.WBC count and the risk of cancer mortality in a national sample of U.S. adults: results from the Second National Health and Nutrition Examination Survey mortality study[J]. Cancer Epidemiol Biomarkers Prev,2004,13(6):1052-1056.
[12] Jee SH, Park JY, Kim HS, et al.White blood cell count and risk for all-cause, cardiovascular, and cancer mortality in a cohort of Koreans[J]. Am J Epidemiol,2005,162(11):1062-1069.
[13] Huang W, Wang F, Li Y, et al.Leukemoid reaction in sarcomatoid renal cell carcinoma: a two-case report[J]. World J Surg Oncol,2014,12:100.
[14] Riesenberg H, Muller F, Gorner M.Leukemoid reaction in a patient with adenocarcinoma of the lung: a case report[J]. J Med Case Rep,2012,6:211.
[15] Coffelt SB, De Visser KE.Cancer: Inflammation lights the way to metastasis[J]. Nature,2014,507(7490):48-49.
[16] Colotta F, Allavena P, Sica A, et al.Cancer-related inflammation, the seventh hallmark of cancer: links to genetic instability[J]. Carcinogenesis,2009,30(7):1073-1081.
[17] Solinas G, Marchesi F, Garlanda C, et al.Inflammation-mediated promotion of invasion and metastasis[J]. Cancer Metastasis Rev,2010,29(2):243-248.