Email updates

Keep up to date with the latest news and content from BMC Cancer and BioMed Central.

Open Access Highly Accessed Research article

Prognostic value of C-reactive protein and neutrophil-to-lymphocyte ratio in patients with hepatocellular carcinoma

Byong Sun Oh1, Jeong Won Jang15*, Jung Hyun Kwon1, Chan Ran You1, Kyu Won Chung1, Chul Seung Kay2, Hyun Suk Jung3 and Seungok Lee4

Author affiliations

1 Department of Internal Medicine, The Catholic University of Korea, Incheon St. Mary’s Hospital, Incheon, Korea

2 Department of Radiation Oncology, The Catholic University of Korea, Incheon St. Mary’s Hospital, Incheon, Korea

3 Department of Radiology, The Catholic University of Korea, Incheon St. Mary’s Hospital, Incheon, Korea

4 Department of Laboratory Medicine, The Catholic University of Korea, Incheon St. Mary’s Hospital, Incheon, Korea

5 Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, #222 Banpo-daero 22-gil, Seocho-gu, Seoul, 137-701, Korea

For all author emails, please log on.

Citation and License

BMC Cancer 2013, 13:78  doi:10.1186/1471-2407-13-78

Published: 15 February 2013

Abstract

Background

Accumulating evidence indicates that components of the systemic inflammatory response, such as C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR), have been associated with prognosis of various cancers. We aimed to elucidate whether CRP and NLR could serve as potential surrogate markers for response and survival in patients with hepatocellular carcinoma (HCC).

Methods

The study population consisted of 318 consecutive patients with HCC. CRP and NLR were measured at baseline with follow-up measurements.

Results

With the mean follow-up of 13.9 months, the median survival time was 13.8 months. Child-Pugh class, tumor size > 5 cm, tumor multiplicity, presence of portal vein thrombosis, α-fetoprotein > 200 ng/mL, CRP > 6.3 mg/L and NLR > 2.3 were identified as independent factors for worse survival of HCC (all p < 0.05). Patients with elevated CRP (> 6.3 mg/L) and elevated NLR (> 2.3) had a significantly shorter overall survival than those with low CRP and low NLR (all p < 0.001). The combined use of CRP and NLR provided incremental prognostic information. With significant inter-correlations, levels of CRP and NLR escalated with aggravating Child-Pugh class from A to C or progressing tumor stage from I to IV. CRP and NLR on baseline and serial measurements were well predictive of treatment response (p < 0.001).

Conclusions

CRP and NLR are independent indicators for survival in HCC patients, reflecting tumor burden and hepatic reserve. Their role in predicting tumor response and survival is more enhanced when used in combination. This study suggests that CRP and NLR are important prognostic biomarkers for HCC.

Keywords:
Inflammation markers; Neutrophil-to-lymphocyte ratio; C-reactive protein; Hepatocellular carcinoma; Survival