Review Article

Elevated Preoperative Neutrophil-Lymphocyte Ratio Is Associated with Poor Prognosis in Hepatocellular Carcinoma Patients Treated with Liver Transplantation: A Meta-Analysis

Table 1

Characteristics of included studies in this meta-analysis.

First author [ref.]CountryYearNumber (M/F)Age (years)LT typesMC (U/O)Immunosuppressive agentsStudy designCutoff for
LNR (> versus <)
Study endpointsHR with 95% CI
(analysis methods)
SourcesFollow-up time (months)

Na [17] Korea2014224 (184/40)Mean 51.9 ± 6.9 LDLT141/83TAC/CyA + MMF + prednisoloneR6.0 (27/197)OS, DFSOS (M), 2.90 (1.40–6.00)DirectMedian 68
(6–139)
DFS (M), 2.51 (0.99–6.39)Direct

Shindoh [18]Japan2014124 (98/26)Median 56 (37–67)LDLT80/44TAC/CyA + steroid with/without MMFR3.0 (61/62)RFSRFS (M), 1.26 (1.06–1.62) DirectMedian 101.9
(3.5–165.4)

Xiao [19] China2013280 (249/31)Mean 46.5 (20.5–69.1)MixedNATAC/CyA + steroids with/without azathioprine and MMFR4.0 (114/166)OS, RFS, and 1/3/5 years OS/RFSOS (M), 1.70 (1.16–2.47)DirectMean 31.56
(13.2–144.0)
DFS (M), 1.76 (1.22–2.53)Direct

Limaye [20] America2013160 (130/30)Mean 55.4DDLT144/16TAC + steroid with/without MMFR5.0 (28/132)OS, DFS, and 1/3/5 years OS/RFSOS (U), 2.12 (1.41–4.62)DirectMean 38
(1–116)
RFS (U), 6.88 (2.99–16.20)Direct

Motomura [21] Japan2013158 (92/66)Mean 57LDLT94/64TAC/CyA + MMFR4.0 (26/132)OS, RFS, and 1/3/5 years OS/RFSOS (U), 3.81 (2.26–6.41)CurveMedian 40.3
RFS (M), 6.24 (2.52–15.0)Direct

Harimoto [22]Japan2013167 (NA/NA)NALDLT105/62TAC/CyA + steroid and/or MMFR4.0 (26/141)RFSRFS (U), 3.39 (1.73–6.62)DataMedian 46.8

Yoshizumi [23]Japan 2013104 (63/41)Median 58.0 (41–72)LDLT52/52TAC/CyA + steroid and/or MMFR4.0 (21/83)RFS, 1/3/5 years RFSRFS (M), 4.02 (1.38–11.6)DirectMedian 57.9

Wang [24] China2011101 (92/9)Mean 48.4 (27–72)DDLT36/65Calcineurin inhibitors and steroidsR3.0 (33/68)OS, DFS, and 5 years OS/RFSOS (U), 1.79 (1.30–2.46)CurveMean 34.2
(4.56–74.64)
DFS (U), 2.18 (1.46–3.26)Curve

Bertuzzo [25] Italy2011219 (186/33)Median 57 (12–69)DDLT138/81TAC/CyA (majority)R5.0 (23/147)OS, RFS, and 3/5 years OS/RFSOS (M), 4.89 (2.47–9.58)DirectMedian 40
(1–146)
RFS (M), 19.14 (6.95–52.71)Direct

Halazun [26]America2009150 (119/31)Mean 57.1 (29–74)LDLT104/46TAC/CyA + steroid + MMFR5.0 (13/137)OS, DFS, and 1/3/5 years OS/DFSOS (M), 6.10 (2.29–16.29) DirectMean 37.2
(13.2–82.8)
DFS (M), 8.42 (2.85–24.88)Direct

M/F, male : female; NA, not available; LT, liver transplantation; LDLT, living donor liver transplant; DDLT, deceased donor liver transplant; MC, Milan criteria; R, retrospective; TAC, tacrolimus; CyA, cyclosporine; MMF, mycophenolate mofetil; NLR, neutrophil to lymphocyte ratio; OS, overall survival; DFS, disease-free survival; RFS, recurrence-free survival; U, univariate analysis; M, multivariate analysis; and curve, Kaplan-Meier curve.