Abstract
BackgroundThe occurrence and development of hepatocellular carcinoma (HCC) depends largely on such non-tumor factors as inflammatory condition, immune state, viral infection and liver fibrosis. Various inflammation-based prognostic scores have been associated with survival in patients with HCC, such as the neutrophil/lymphocyte ratio (NLR), the platelet/lymphocyte ratio (PLR) and the prognostic nutritional index (PNI). The aspartate aminotransferase/platelet count ratio index (APRI) is thought to be a biomarker of liver fibrosis and cirrhosis. This study aims to evaluate the ability of these indices to predict survival in HCC patients after curative hepatectomy, and probe the increased prognostic accuracy of APRI combined with established inflammation-based prognostic scores.MethodsData were collected retrospectively from 321 patients who underwent curative resection for HCC. Preoperative NLR, PLR, PNI, APRI and clinico-pathological variables were analyzed. Univariate and multivariate analyses were performed to identify the predictive value of the above factors for disease-free survival (DFS) and overall survival (OS).ResultsUnivariate analysis showed that NLR, PLR, PNI and APRI were significantly associated with DFS and OS in HCC patients with curative resection. Multivariate analysis showed that NLR and APRI were superior to PLR and PNI, and both were independently correlated with DFS and OS. Preoperative NLR >2 or APRI >1.68 predicted poor prognosis of patients with HCC after hepatectomy. Furthermore, the predictive range of NLR combined with APRI was more sensitive than that of either measure alone.ConclusionsPreoperative NLR and APRI are independent predictors of DFS and OS in patients with HCC after surgical resection. Higher levels of NLR or APRI predict poorer outcomes in HCC patients. Intriguingly, combining NLR and APRI increases the prognostic accuracy of testing.
Highlights
The occurrence and development of hepatocellular carcinoma (HCC) depends largely on such nontumor factors as inflammatory condition, immune state, viral infection and liver fibrosis
Our results indicated that the optimal cut-off values for neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), prognostic nutritional index (PNI) and aminotransferase/platelet count ratio index (APRI) were 2, 115, 45 and 1.68, respectively (Fig. 1)
We found that AFP, Tumor Node Metastasis (TNM), portal vein tumor thrombus (PVTT), NLR and APRI were significant independent predictors of disease-free survival (DFS), while TNM, PVTT, NLR, PLR and APRI were significant independent predictors of overall survival (OS) (Tables 1 and 2)
Summary
The occurrence and development of hepatocellular carcinoma (HCC) depends largely on such nontumor factors as inflammatory condition, immune state, viral infection and liver fibrosis. Inflammation-based prognostic scores, such as the combination of albumin and lymphocyte counts used in the prognostic nutritional index (PNI) [5, 8], the combination of neutrophil and lymphocyte counts in the neutrophil/ lymphocyte ratio (NLR) [9,10,11], and the combination of platelet (PLT) and lymphocyte counts in the PLT/lymphocyte ratio (PLR) [12], have proved valuable in HCC prediction. Recent studies [13,14,15] suggest that a simple and accurate biochemical marker of liver fibrosis and cirrhosis, i.e., the aspartate aminotransferase (AST)/ PLT count ratio index (APRI), may be 1) an indicator of postoperative prognosis in early stage hepatitis B (HBV)-related HCC patients, or 2) a marker of HCC risk in HBV patients,
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