Prognostic value of preoperative absolute lymphocyte count in recurrent hepatocellular carcinoma following thermal ablation: a retrospective analysis

Purpose: To investigate the prognostic value of preoperative absolute lymphocyte count (ALC) in recurrent hepatocellular carcinoma (RHCC) following thermal ablation. Materials and methods: We retrospectively analyzed the relationship between preoperative ALC and the clinicopathologic factors and long-term prognosis in 423 RHCC patients who underwent curative thermal ablation. Correlation analysis, receiver operating characteristic (ROC) calculation, Kaplan-Meier curves, and multivariate regression were used for statistical analysis. Results: The median time to recurrence was 12 months for RHCC patients after thermal ablation. On multivariate Cox regression analysis, preoperative ALC was an independent risk factor for cancer recurrence, along with tumor differentiation and alpha-fetoprotein level. ALC >= 1.64x109/L defined by ROC calculation was associated with prolonged survival (area under the curve 0.741, P, 0.001). Patients with ALC >= 1.64x109/L showed a mean survival of 20.2 months versus 11.6 months for patients with ALC < 1.64x109/L (P < 0.001). Patients were stratified into high and low groups according to ALC status. After excluding the basic parameters between groups, the 1- and 3-year recurrence rates in the high group were 20.9% and 29.5%, respectively, which were significantly lower than those of the low group (58.4% and 71.9%, respectively; P < 0.001). The recurrence-free survival rates in the two groups analyzed by Kaplan-Meier curves were significantly different (P < 0.001). Conclusion: Preoperative ALC is a powerful prognostic factor for RHCC recurrence after thermal ablation, which suggests that maintaining a high ALC in RHCC patients might improve cancer outcomes.