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

Document Type : Research Articles


Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.


Background: Recurrence after curative resection of hepatocellular carcinoma (HCC) is associated with early death
and poor prognosis. Microvascular invasion (mVI) is strongly associated with disease recurrence. Although many studies
have examined the relationship between various serum inflammatory indices and post-treatment prognosis, little is
known about preoperative predictors of microvascular invasion in HCC. Methods: Patients who underwent curative
hepatic resection for HCC at our institute from January 2006 to December 2016 were retrospectively reviewed. The
associations 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-off
values were determined using receiver operating characteristic curves. Results: A total of 330 HCC patients were
enrolled in this study, of whom 74 (22.4%) had tumors with mVI. After univariate analysis, two parameters were
significantly 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 after
multivariate 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 independent
predictive factors for mVI in HCC.


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