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Platelet-to-lymphocyte ratio in the setting of liver transplantation for hepatocellular cancer: A systematic review and meta-analysis
Authors:Quirino Lai  Fabio Melandro  Zoe Larghi Laureiro  Francesco Giovanardi  Stefano Ginanni Corradini  Flaminia Ferri  Redan Hassan  Massimo Rossi  Gianluca Mennini
Affiliation:Quirino Lai, Fabio Melandro, Zoe Larghi Laureiro, Francesco Giovanardi, Redan Hassan, Massimo Rossi, Gianluca Mennini, Hepato-bilio-pancreatic and Liver Transplant Unit, Department of Surgery, Sapienza University of Rome, Rome 00161, ItalyStefano Ginanni Corradini, Flaminia Ferri, Division of Gastroenterology, Department of Clinical Medicine, Sapienza University of Rome, Rome 00161, Italy
Abstract:AIM To perform a systematic review and meta-analysis on platelet-to-lymphocyte ratio(PLR) as a risk factor for post-transplant hepatocellular cancer(HCC) recurrence. METHODS A systematic literature search was performed using PubM ed. Participants of any age and sex, who underwent liver transplantation for HCC were considered following these criteria:(1) studies comparing pre-transplant low vs high PLR values;(2) studies reporting post-transplant recurrence rates; and(3) if more than one study was reported by the same institute, only the most recent was included. The primary outcome measure was set for HCC recurrence after transplantation. RESULTS A total of 5 articles, published between 2014 and 2017, fulfilled the selection criteria. As for the quality of the reported studies, all the investigated articles presented an overall high quality. A total of 899 cases were investigated: 718 cases(80.0%) were males. Three studies coming from European countries and one from Japan presented HCV as the main cause of cirrhosis. On the opposite, one Chinese study presented a greater incidence of HBV-related cirrhotic cases. In all the studies apart one, the PLR cut-off value of 150 was reported. At meta-analysis, high PLR value was associated with a significant increase in recurrence after transplantation(OR = 3.33; 95%CI: 1.78-6.25; P 0.001). A moderate heterogeneity was observed among the identified studies according to the Higgins I~2 statistic value.CONCLUSION Pre-transplant high PLR values are connected with an increased risk of post-operative recurrence of hepatocellular cancer. More studies are needed for better clarify the biological mechanisms of this results.
Keywords:Recurrence   Inflammation   Hepatocellular cancer   Liver transplantation   Platelet-to-lymphocyte ratio
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