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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 4/2024

05-01-2024 | Lymphopenia | Hepatobiliary Tumors

Perioperative Lymphopenia is Associated with Increased Risk of Recurrence and Worse Survival Following Hepatectomy for Hepatocellular Carcinoma

Authors: Diamantis I. Tsilimigras, MD, Yutaka Endo, MD, Francesca Ratti, MD, Hugo P. Marques, MD, François Cauchy, MD, Vincent Lam, MD, George A. Poultsides, MD, Irinel Popescu, MD, Sorin Alexandrescu, MD, Guillaume Martel, MD, Minoru Kitago, MD, Alfredo Guglielmi, MD, Tom Hugh, MD, Luca Aldrighetti, MD, Ana Gleisner, MD, Feng Shen, MD, Itaru Endo, MD, PhD, Timothy M. Pawlik, MD, MPH, PhD, FACS, FRACS (Hon.)

Published in: Annals of Surgical Oncology | Issue 4/2024

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Abstract

Introduction

Immune dysregulation may be associated with cancer progression. We sought to investigate the prognostic value of perioperative lymphopenia on short- and long-term outcomes among patients undergoing resection of hepatocellular carcinoma (HCC).

Methods

Patients undergoing resection of HCC between 2000 and 2020 were identified using an international database. The incidence and impact of perioperative lymphopenia [preoperative, postoperative day (POD) 1/3/5], defined as absolute lymphocyte count (ALC) <1000/μL, on short- and long-term outcomes was assessed.

Results

Among 1448 patients, median preoperative ALC was 1593/μL [interquartile range (IQR) 1208–2006]. The incidence of preoperative lymphopenia was 14.0%, and 50.2%, 45.1% and 35.6% on POD1, POD3 and POD5, respectively. Preoperative lymphopenia predicted 5-year overall survival (OS) [lymphopenia vs. no lymphopenia: 49.1% vs. 66.1%] and 5-year disease-free survival (DFS) [25.0% vs. 41.5%] (both p < 0.05). Lymphopenia on POD1 (5-year OS: 57.1% vs. 71.2%; 5-year DFS: 30.0% vs. 41.1%), POD3 (5-year OS: 57.3% vs. 68.9%; 5-year DFS: 35.4% vs. 42.7%), and POD5 (5-year OS: 53.1% vs. 66.1%; 5-year DFS: 32.8% vs. 42.3%) was associated with worse long-term outcomes (all p < 0.05). Patients with severe lymphopenia (ALC <500/μL) on POD5 had worse 5-year OS and DFS (5-year OS: 44.7% vs. 54.3% vs. 66.1%; 5-year DFS: 27.8% vs. 33.3% vs. 42.3%) [both p < 0.05], as well as higher incidence of overall (45.5% vs. 25.3% vs. 30.9%; p = 0.013) and major complications (18.2% vs. 3.4% vs. 4.5%; p < 0.001) versus individuals with moderate (ALC 500–1000/μL) or no lymphopenia following hepatectomy for HCC. After adjusting for competing risk factors, prolonged lymphopenia was independently associated with higher hazards of death [hazard ratio (HR) 1.38, 95% CI 1.11–1.72] and recurrence (HR 1.22, 95% CI 1.02–1.45).

Conclusion

Perioperative lymphopenia had short- and long-term prognostic implications among individuals undergoing hepatectomy for HCC.
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Metadata
Title
Perioperative Lymphopenia is Associated with Increased Risk of Recurrence and Worse Survival Following Hepatectomy for Hepatocellular Carcinoma
Authors
Diamantis I. Tsilimigras, MD
Yutaka Endo, MD
Francesca Ratti, MD
Hugo P. Marques, MD
François Cauchy, MD
Vincent Lam, MD
George A. Poultsides, MD
Irinel Popescu, MD
Sorin Alexandrescu, MD
Guillaume Martel, MD
Minoru Kitago, MD
Alfredo Guglielmi, MD
Tom Hugh, MD
Luca Aldrighetti, MD
Ana Gleisner, MD
Feng Shen, MD
Itaru Endo, MD, PhD
Timothy M. Pawlik, MD, MPH, PhD, FACS, FRACS (Hon.)
Publication date
05-01-2024
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 4/2024
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-023-14811-7

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