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Background: The neutrophil to lymphocyte ratio (NLR) is a marker of inflammation and is associated with poor outcomes. We aimed to evaluate the role of the pretreatment NLR in predicting the outcomes after preoperative chemotherapy in patients with colorectal liver metastases (CRLM)., Methods: A retrospective review was performed for 183 patients with CRLM. The NLR was measured before chemotherapy, and a receiver operating characteristic (ROC) curve was used to estimate the cutoff value. Logistic regressions were applied to analyze potential predictors of the pathological response. The Cox proportional hazard method was used to analyze survival., Results: The pre-chemotherapy NLR was 2.4 ± 1.1, whereas the post-chemotherapy NLR was 2.1 ± 1.6 (p < 0.001). The pretreatment NLR of 2.3 was a significant predictive marker for the pathological response. The pathological response rates were 67.1% in the patients with an NLR ≤ 2.3 and 48.1% in patients with an NLR > 2.3 (p = 0.01). Multivariate analysis revealed that the factors independently associated with pathological responses were a low pretreatment NLR (p = 0.043), radiological response to chemotherapy (p < 0.001), first-line chemotherapy (p = 0.001), and targeted therapy (p = 0.002). The median overall survival (OS) and recurrence-free survival (RFS) were worse in the increased NLR cohort than in the low NLR cohort (OS: 31.1 vs. 43.1 months, p = 0.012; RFS: 6.5 vs. 9.4 months, p = 0.06). According to multivariate analyses, a high pretreatment NLR was a significant predictor for both worse OS (HR = 2.43, 95%CI = 1.49-3.94, p < 0.001) and RFS (HR = 1.53, 95%CI = 1.08-2.18, p = 0.017)., Conclusions: An increased pretreatment NLR was a significant predictor of a poor pathological response and worse prognosis after preoperative chemotherapy. The NLR is a simple biomarker for assessing chemotherapy efficacy.

Assessing the prognosis of patients with hepatocellular carcinoma (HCC) by the number and size of tumors is sometimes difficult. The main purpose of the study was to evaluate the prognostic value of total tumor volume (TTV), which combines the two factors, in patients with HCC who underwent liver resection. We retrospectively reviewed 521 HCC patients from January 2001 to December 2008 in our center. Patients were categorized using the tertiles of TTV. The prognostic value of TTV was assessed. With a median follow-up of 116 months, the 1-, 3-, and 5-year overall survival (OS) rates of the patients were 93.1 , 69.9, and 46.3 %, respectively. OS was significantly differed by TTV tertile groups, and higher TTV was associated with shorter OS (P < 0.001). Multivariate analysis revealed that TTV was an independent prognostic factor for OS. Larger TTV was significantly associated with higher alpha-fetoprotein level, presence of macrovascular invasion, multiple tumor lesions, larger tumor size, and advanced tumor stages (all P < 0.05). Within the first and second tertiles of TTV (TTV ≤ 73.5 cm(3)), no significant differences in OS were detected in patients within and beyond Milan criteria (P = 0.183). TTV-based Cancer of the Liver Italian Program (CLIP) score gained the lowest Akaike information criterion value, the highest χ (2) value of likelihood ratio test, and the highest C-index among the tested staging systems. Our results suggested that TTV is a good indicator of tumor burden in patients with HCC. Further studies are warranted to validate the prognostic value of TTV.

Objective: To investigate the prognostic factors of hepatocellular carcinoma., Methods: The purpose of this study was to retrospectively analyze the surgical outcomes of hepatocellular carcinoma (HCC) in 832 patients who underwent hepatic resection between February 2002 and June 2010 in the Cancer Hospital of Chinese Academy of Medical Sciences. Post-resection prognostic factors were assessed using a univariate Kaplan-Meier analysis and a multivariate Cox proportional hazards model., Results: The overall 1-, 3- and 5-year survival rates were 92.0%, 70.2% and 53.6%, respectively. The disease free survival rates (DFS) were 90.2%, 61.5% and 40.5%, respectively. The univariate analysis showed that a better prognosis for overall survival (OS) was associated with asymptomatic presentation, small tumor, single lesion, high-grade histological differentiation, no vascular tumor embolus, negative serum alpha-fetoprotein (AFP), negative serum alkaline phosphatase (ALP), Child-Pugh class A, no ascites, no/mild cirrhosis, new surgical techniques, no blood transfusion, no regional lymph node metastasis, no major vascular invasion, and no extra-hepatic invasion. The multivariate analysis showed that asymptomatic presentation, small tumor, single lesion, no tumor embolus, negative serum alpha-fetoprotein (AFP), no regional lymph node metastasis, no major vascular invasion, no extra-hepatic invasion, no/mild cirrhosis, and surgical techniques are independent factors for a longer overall survival., Conclusions: The prognosis of HCC after resection is influenced by a number of factors. Therefore, regularly screening and early diagnosis, applying surgical techniques to minimize the liver injury, and preventing the aggravation of cirrhosis are important measures to improve the overall survival of HCC patients. For those patients with high risk factors of recurrence, routine follow-up is one of the best methods to be recommended.

Objective: To analyze the clinicopathologic factors influencing the outcome of surgically treated intrahepatic cholangiocarcinoma (ICC) and to explore the proper treatment choice of ICC., Methods: The clinicopathological data of 43 surgically treated ICC patients in our hospital were retrospectively analyzed. Of the 43 patients, hepatic resection was performed in 40 patients, ethanol injection in 2, and laparoscopic exploration alone in 1. Kaplan-Meier method and Cox regression model were used for the analysis of factors influencing survival after operation., Results: The accumulative 1-, 3- and 5-year survival rates were 64.4%, 30.9%, 25.8% for the whole group, and 74.7%, 33.3%, 27.8% for the 40 patients with hepatic resection, respectively. Univariate analysis revealed that tumor size, carcinoembryonic antigen (CEA) level, lymph node involvement and TNM stage were factors significantly affecting the survival (P < 0.05). Cox multivariate analysis demonstrated that only tumor size and lymph node involvement were the independent factors significantly affecting the survival (P < 0.05)., Conclusion: Our results show that tumor size and lymph node involvement are independent factors affecting the survival. CEA level and TNM stage are important prognostic factors for surgical management. Radical resection is still the optimal treatment for patient with intrahepatic cholangiocarcinoma.

Objective: To investigate the effectiveness of anatomic method of separation in hepatectomy methods of decreasing postoperative complication and mortality for liver cancer patients., Methods: The clinical data of 398 patients with liver malignant tumors, admitted in our hospital during 2001 to 2007, were retrospectively analyzed. The anatomic method group (group A) included 243 contiguous patients of liver cancer who received hepatectomy by anatomical method of separation, while the traditional method group (group B) included 155 patients of liver cancer who received hepatectomy by traditional method of separation during the same period. Blood loss and transfusion during operation, postoperative liver function, complication and mortality of operation, and postoperative hospital stay were compared between these two groups., Results: In group A, the tumor diameters ranged (6.02 +/- 3.24) cm, the operative blood loss was (445 +/- 240) ml, and 52 patients (24.3%) underwent blood transfusion [range: (520 +/- 280) ml]. No mortality and intraabdominal hemorrhage, liver function failure, or other severe complications were noted. Only 12 patients (4.9%) suffered mild complications. The postoperative hospital stay was (13.4 +/- 4.9) days. In group B, the tumor diameters ranged (5.84 +/- 2.93 cm, the operative blood loss was (1200 +/- 320) ml, and 53 patients (34.2%) underwent transfusion [range: (1400 +/- 623) ml]. Five patients (3.23%) died within 30 days after operation. The total complication morbidity was 16.1% (25/155). Five patients suffered intraabdominal hemorrhage and 5 experienced liver function failure. Postoperative hospital stay was (18.9 +/- 10.3) days. The volume of blood loss and transfusion in group A were significantly less than in group B (P < 0.05). Mortality, severe complications, and total complication morbidity were significantly lower in group A than in group B (P < 0.05, P < 0.01). The postoperative stay was also significantly shorter in group A than in group B (P < 0.05)., Conclusion: Anatomical method of separation is an effective method of hepatectomy with relatively low complication and mortality.

Objective: To discuss the long-term effect of united liver and spleen resection on treatment of hepatocellular carcinoma (HCC) complicated with cirrhosis and hypersplenism., Methods: The clinical data of 102 patients of HCC complicated with cirrhosis and hypersplenism, 57 receiving united hepatectomy and splenectomy (group A), and 45 receiving hepatectomy only (group B), were retrospectively examined., Results: The volume of operative blood loss of group A was 765 ml (100 - 2,400 ml), not significantly different from that of group B (720 ml, 200 - 2,000 ml). The operative morbidity was 1.7% (1/57) of group A, significantly higher lower than that of group B (4.4%, 2/45). After the operation, the platelet count increased to 275.8 x 10(9)/L in group A, significantly higher than that in group B (83 x 10(9)/L, P < 0.05); and the white blood cell count of group A increased to 10.4 x 10(9)/L, significantly higher than that of group B (4.19 x 10(9)/L, P < 0.05). Post-operative gamma glutamyl transferase, a prognostic factor for liver cirrhosis, of group A was 68 U/L, significantly lower than that of group B (132 U/L, P < 0.05). The incidence of complication was 29.8% (17/57) in group A, not significantly different from that of group B (33.3%, 15/45). The 1, 3, and 5-year recurrence rates were 27.1%, 48.6%, and 69.3% in group A, versus 41.2%, 50.0%, and 77.9% in group B, whereas the 1, 3, and 5-year survival rates were 92.6%, 59.1%, and 41.8% in group A, versus 80.3%, 43.9%, and 29.1% in the group B. The longest survival time in group A was 12.9 months, significantly longer than that in group B (6.3 months, P < 0.01)., Conclusion: United liver and spleen resection is a safe and effective modality for the treatment of HCC complicated with cirrhosis and hypersplenism.