Hepatology International

, Volume 13, Issue 5, pp 609–617 | Cite as

Association between neutrophil–lymphocyte ratio, socioeconomic status, and ethnic minority with treatment outcome in hepatocellular carcinoma

  • Yifei Zhang
  • N. Patrik Brodin
  • Nitin Ohri
  • Santiago Thibaud
  • Andreas Kaubisch
  • Milan Kinkhabwala
  • Madhur Garg
  • Chandan Guha
  • Rafi KabarritiEmail author
Original Article



Patients with lower socioeconomic status (SES), ethnic minorities and elevated neutrophil–lymphocyte ratio (NLR) have been suggested to have worse outcomes in hepatocellular carcinoma (HCC). However, how changes in NLR after intervention relate to survival has not been elucidated.


We evaluated the association of NLR with overall survival (OS) and progression-free survival (PFS) in a large institutional cohort of HCC.


We reviewed all patients diagnosed with HCC between 2005–2016. The association between elevated NLR (> 4) and survival was examined with univariable and multivariable Cox regression.


We identified 991 patients diagnosed with HCC. Lower SES and Hispanic and non-Hispanic Black ethnicity were significantly associated with lower NLR (p = 0.015 and 0.019, respectively). Elevated NLR, but not SES or ethnicity, was an independent predictor of worse OS (HR = 1.66, p < 0.001) and PFS (HR = 1.25, p = 0.032). The median OS in patients with elevated NLR was 8 months, compared to 42 months in patients with normal NLR. Patients with elevated NLR unresponsive to treatment and those with NLR that became elevated after treatment had significantly worse 3-year OS (47% and 44%, respectively), compared to patients whose NLR remained normal or normalized after treatment (72% and 80%, respectively; p < 0.01).


Our study showed that elevated NLR, but not SES or ethnicity, is an independent prognostic marker for OS and PFS in patients with HCC. NLR trends following intervention were highly predictive of outcome. NLR is easy to obtain and would provide valuable information to clinicians in evaluating prognosis and monitoring response after procedures.


Hepatocellular carcinoma Socioeconomic status Ethnicity Neutrophil-to-lymphocyte ratio Prognosis 


Compliance with ethical standards

Conflict of interest

Yifei Zhang, N. Patrik Brodin, Nitin Ohri, Santiago Thibaud, Andreas Kaubisch, Milan Kinkhabwala, Madhur Garg, Chandan Guha and Rafi Kabarriti declare that they have no conflict of interest.

Ethical approval

The study protocol has been approved by the institute’s committee on human research.

Supplementary material

12072_2019_9965_MOESM1_ESM.doc (29 kb)
Supplementary material 1 (DOC 29 kb)


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Copyright information

© Asian Pacific Association for the Study of the Liver 2019

Authors and Affiliations

  • Yifei Zhang
    • 1
  • N. Patrik Brodin
    • 2
  • Nitin Ohri
    • 2
  • Santiago Thibaud
    • 1
  • Andreas Kaubisch
    • 1
  • Milan Kinkhabwala
    • 3
  • Madhur Garg
    • 2
  • Chandan Guha
    • 2
  • Rafi Kabarriti
    • 2
    Email author
  1. 1.Department of Medicine (Oncology), Montefiore Medical CenterAlbert Einstein College of MedicineBronxUSA
  2. 2.Department of Radiation Oncology, Montefiore Medical CenterAlbert Einstein College of MedicineBronxUSA
  3. 3.Department of Surgery, Montefiore Medical CenterAlbert Einstein College of MedicineBronxUSA

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