Abstract
BackgroundHepatocellular carcinoma (HCC) is the most common pathological type of primary liver cancer. The lack of prognosis indicators is one of the challenges in HCC. In this study, we investigated the combination of tertiary lymphoid structure (TLS) and several systemic inflammation parameters as a prognosis indicator for HCC.Materials and MethodsWe retrospectively recruited 126 postoperative patients with primary HCC. The paraffin section was collected for TLS density assessment. In addition, we collected the systemic inflammation parameters from peripheral blood samples. We evaluated the prognostic values of those parameters on overall survival (OS) using Kaplan-Meier curves, univariate and multivariate Cox regression. Last, we plotted a nomogram to predict the survival of HCC patients.ResultsWe first found TLS density was positively correlated with HCC patients’ survival (HR=0.16, 95% CI: 0.06 − 0.39, p < 0.0001), but the power of TLS density for survival prediction was found to be limited (AUC=0.776, 95% CI:0.772 − 0.806). Thus, we further introduced several systemic inflammation parameters for survival analysis, we found neutrophil-to-lymphocyte ratio (NLR) was positively associated with OS in univariate Cox regression analysis. However, the combination of TLS density and NLR better predicts patient’s survival (AUC=0.800, 95% CI: 0.698-0.902, p < 0.001) compared with using any single indicator alone. Last, we incorporated TLS density, NLR, and other parameters into the nomogram to provide a reproducible approach for survival prediction in HCC clinical practice.ConclusionThe combination of TLS density and NLR was shown to be a good predictor of HCC patient survival. It also provides a novel direction for the evaluation of immunotherapies in HCC.
Highlights
Primary liver cancer is the third leading cause of cancer-related deaths globally, accounting for approximately 782,500 deaths annually
We found that tertiary lymphoid structure (TLS) and several systemic inflammation parameters were correlated with Hepatocellular carcinoma (HCC) patients’ survival (Figures 2B, 3E–H)
Our results suggest that both TLSs and NLR are good predictors of the prognosis in HCC patients, but limitations on survival prediction based on a single parameter were observed
Summary
Primary liver cancer is the third leading cause of cancer-related deaths globally, accounting for approximately 782,500 deaths annually. Hepatocellular carcinoma (HCC) is the most predominant type of primary liver cancer, comprising about 90% of cases [1, 2]. Systemic therapy options for HCC are limited, and early-stage HCC was prone to recurrence and metastasis after surgery. The complex tumor microenvironment of HCC was believed to contribute to the difficulty of treating patients with HCC [4]. Many predictive markers for prognosis and postoperative recurrence and metastasis in patients with HCC have been proposed. Hepatocellular carcinoma (HCC) is the most common pathological type of primary liver cancer. The lack of prognosis indicators is one of the challenges in HCC. We investigated the combination of tertiary lymphoid structure (TLS) and several systemic inflammation parameters as a prognosis indicator for HCC
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