Neutrophil Lymphocyte Ratio to Albumin Ratio and White Blood Cell to Hemoglobin Ratio as Prognostic Markers for Hepatocellular Carcinoma Patients Who Underwent Curative Hepatectomy

Figures & data

Table 1 Clinicopathological Variables of the Enrolled Patients

Variables	N = 169
Sex (Male/Female)	139/30 (82.2/17.8)
Age (years, ≤60/>60)	80/89 (47.3/52.7)
AFP (ng/mL, <400/≥400)	115/54 (68.0/42.0)
PLT (×10^9/L)	(127, 7–355)
ALB (g/L, <35/≥35)	36/133 (21.3/78.7)
ALT (U/L, <40/≥40)	111/58 (65.7/34.3)
TBIL(umol/L, <35/≥35)	157/12 (92.9/7.1)
Tumor size (cm, <5/≥5)	78/91 (46.2/53.8)
Tumor number (solitary/multiple)	139/30 (82.2/17.8)
Tumor stage (I/II–III)	106/63 (62.7/37.3)
Surgical procedure (AR/NAR)	112/57 (66.3/33.7)
NLRAR	(0.0600, 0.0095–1.2043)
WHR	(4.07, 1.59–12.07)
NWS (low risk/high risk)	124/45 (73.4/26.6)

Note: Values are presented as the median (range) or n (%).

Abbreviations: AFP, alpha-fetoprotein; ALB, albumin; PLT, platelet; ALT, alanine aminotransferase; TBIL, total bilirubin; AR, Anatomic resection; NAR, non-anatomic resection; NLRAR, neutrophil lymphocyte ratio to albumin ratio; WHR, white blood cell to hemoglobin ratio; NWS: NLRAR-WHR scoring system.

Figure 1 Cut-off values identified using the X-tile software.

Figure 2 Kaplan–Meier survival curves plotted using data collected from HCC patients undergoing hepatectomy for overall survival. (A) Overall survival rates stratified by NLRAR. (B) Overall survival rates stratified by WHR. (C) Overall survival rates stratified by NWS.

Abbreviations: HCC, hepatocellular carcinoma; NLRAR, neutrophil lymphocyte ratio to albumin ratio; WHR, white blood cell to hemoglobin ratio; NWS: NLRAR–WHR scoring system.

Table 2 Univariate and Multivariate Cox Analyses of Inflammation Markers for Overall Survival

Inflammation Based Markers	Univariate Analyses			Multivariate Analyses
	HR	95% CI	P	HR	95% CI	P
NLRAR (elevated/decreased)	3.05	1.43–6.50	0.004	3.01*	1.36–6.65	<0.01
WHR (elevated/decreased)	2.06	1.07–3.96	0.03	2.40^#	1.17–4.93	<0.05
NWS (high risk/low risk)	3.35	1.74–6.45	<0.001	3.66*	1.77–7.59	<0.001

Notes: *HR and 95% CI from multivariate Cox analysis after adjusting for Age, Sex, AFP, PLT, ALT, TBIL, Tumor size, Tumor number, Tumor stage and Surgical procedure. #HR and 95% CI from multivariate Cox analysis after adjusting for Age, Sex, AFP, PLT, ALB, ALT, TBIL, Tumor size, Tumor number, Tumor stage and Surgical procedure.

Abbreviations: NLRAR, neutrophil lymphocyte ratio to albumin ratio; WHR, white blood cell to hemoglobin ratio; NWS, NLRAR–WHR scoring system.

Figure 3 The predictive power of inflammation markers in overall survival rates for HCC patients undergoing hepatectomy. (A–C) Receiver operating characteristic curve analysis for inflammation markers for 1-, 2- and 3-year overall survival rates. (D) Decision curve analysis (DCA) for inflammation markers at clinical benefits.

Figure 4 Subgroup analyses for inflammation markers in HCC patients undergoing hepatectomy stratified by different tumor stages. (A–C) Kaplan-Meier survival curves for overall survival rates at tumor stage I. (D–F) Kaplan-Meier survival curves for overall survival rates at tumor stages II–III. (G–I) Receiver operating characteristic curve analysis for the determination of 1-, 2- and 3-year overall survival rates at tumor stage I.

Figure 5 Correlations between inflammation markers and clinicopathological features.

Figure 6 Pearson correlation analysis. (A) Negative correlation between albumin and NLR; (B) positive correlation between WHR and NLRAR. (C) No significant correlation was observed between hemoglobin and white blood cell.

Abbreviations: NLR, neutrophil lymphocyte ratio; NLRAR, neutrophil lymphocyte ratio to albumin ratio; WHR, white blood cell to hemoglobin ratio; NWS, NLRAR–WHR scoring system.