Platelet-to-Lymphocyte Ratio and Large Tumor Size Predict Microvascular Invasion after Resection for Hepatocellular Carcinoma

Background: Recurrence after curative resection of hepatocellular carcinoma (HCC) is associated with early deathand poor prognosis. Microvascular invasion (mVI) is strongly associated with disease recurrence. Although many studieshave examined the relationship between various serum inflammatory indices and post-treatment prognosis, little isknown about preoperative predictors of microvascular invasion in HCC. Methods: Patients who underwent curativehepatic resection for HCC at our institute from January 2006 to December 2016 were retrospectively reviewed. Theassociations between mVI and various potential risk factors, including tumor size, hepatitis B and C virus infection,Child–Pugh scores, platelet-to-lymphocyte ratio, and neutrophil-to-lymphocyte ratio, were analyzed. Optimal cut-offvalues were determined using receiver operating characteristic curves. Results: A total of 330 HCC patients wereenrolled in this study, of whom 74 (22.4%) had tumors with mVI. After univariate analysis, two parameters weresignificantly associated with mVI after hepatic resection: platelet-to-lymphocyte ratio ≥102 (odds ratio [OR] 2.385,p = 0.001) and tumor size ≥5 cm (OR 4.29, p < 0.001). Both variables remained significant risk factors for mVI aftermultivariate analysis: platelet-to-lymphocyte ratio ≥102 (OR 1.831, p = 0.034) and tumor size ≥5 cm (OR 3.791,p < 0.001). Conclusions: Large tumor size (≥5 cm) and high platelet-to-lymphocyte ratio (≥102) are independentpredictive factors for mVI in HCC.     

Correlation of serum albumin and prognostic nutritional index with outcomes following pancreaticoduodenectomy

BACKGROUND Pancreaticoduodenectomy(PD) is a complex surgical procedure with a high morbidity rate. The serious complications are major risk factors for poor longterm surgical outcome. Studies have reported an association between early postoperative prognostic nutritional index(PNI) and prediction of severe complications after abdominal surgery. However, there have been no studies on the use of early postoperative PNI for predicting serious complications following PD.AIM To analyze the risk factors and early postoperative PNI for predicting severe complications following PD.METHODS We retrospectively analyzed 238 patients who underwent PD at our hospital between January 2007 and December 2017. The postoperative complications were classified according to the Dindo-Clavien classification. Grade Ⅲ-Ⅴ postoperative complications were classified as serious. The risk factors for serious complications were analyzed by univariate analysis and multivariate logistic regression analysis.RESULTS Overall complications were detected in 157 of 238 patients(65.9%) who underwent PD. The grade Ⅲ-Ⅴ complication rate was 26.47%(63/238 patients).The mortality rate was 3.7%(9/238 patients). Multivariate logistic regression analysis revealed that preoperative serum albumin [odds ratio(OR): 0.883, 95%confidence interval(CI): 0.80-0.96; P < 0.01] and PNI on postoperative day 3 <40.5(OR: 2.77, 95%CI: 1.21-6.38, P < 0.05) were independent factors associated with grade Ⅲ-Ⅴ postoperative complications.CONCLUSION Perioperative albumin is an important factor associated with serious complications following PD. Low early postoperative PNI(< 40.5) is a predictor for serious complications.