Abstract
BackgroundSeveral inflammation-based scores are used to assess the surgical outcomes of hepatocellular carcinoma (HCC). The aim of the present study was to elucidate the prognostic value of the prognostic nutritional index (PNI) in HCC patients who underwent hepatectomy with special attention to preoperative liver functional reserve.MethodsPreoperative demographic and tumor-related factors were analyzed in 189 patients with HCC undergoing initial hepatectomy from August 2005 to May 2016 to identify significant prognostic factors.ResultsMultivariate analysis for overall survival (OS) revealed that female sex (p = 0.005), tumor size (p < 0.001) and PNI (p = 0.001) were independent prognostic factors. Compared to the High PNI group (PNI ≥ 37, n = 172), the Low PNI group (PNI < 37, n = 17) had impaired liver function and significantly poorer OS (13% vs. 67% in 5-year OS, p = 0.001) and recurrence-free survival (RFS) (8 vs. 25 months in median PFS time, p = 0.002). In the subgroup of patients with a preserved liver function of LHL15 ≥ 0.9, PNI was also independent prognostic factor, and OS (21% vs. 70% in 5-year OS, p = 0.008) and RFS (8 vs. 28 months in median PFS time, p = 0.018) were significantly poorer in the Low PNI group than the High PNI group.ConclusionsPNI was an independent prognostic factor for HCC patients who underwent hepatectomy. Patients with PNI lower than 37 were at high risk for early recurrence and poor patient survival, especially in the patients with preserved liver function of LHL ≥ 0.9.
Highlights
Several inflammation-based scores are used to assess the surgical outcomes of hepatocellular carcinoma (HCC)
In addition to tumor biological and liver functional status, there is increasing evidence that several inflammation-based scores predict the prognosis of patients with malignancies, including HCC, because the host inflammatory response plays an important role in carcinogenesis and progression via the enhancement of proliferative signals, facilitation of angiogenesis, and promotion of invasion and metastasis
prognostic nutritional index (PNI) and Glasgow Prognostic Score (GPS) consist of albumin and lymphocytes or C-reactive protein (CRP), which may reflect the balance between the pro-tumor inflammatory status and nutritional status
Summary
Several inflammation-based scores are used to assess the surgical outcomes of hepatocellular carcinoma (HCC). Compared to other malignancies, the prognosis of patients with HCC is highly influenced by tumor extension and the severity of the underlying liver function. In addition to tumor biological and liver functional status, there is increasing evidence that several inflammation-based scores predict the prognosis of patients with malignancies, including HCC, because the host inflammatory response plays an important role in carcinogenesis and progression via the enhancement of proliferative signals, facilitation of angiogenesis, and promotion of invasion and metastasis. PNI and GPS consist of albumin and lymphocytes or C-reactive protein (CRP), which may reflect the balance between the pro-tumor inflammatory status and nutritional status. Since the 2010s, Onodera’s PNI has been widely used as a predictor of patient survival in various malignant tumors, including gastrointestinal [6,7,8,9] and nongastrointestinal cancers [10,11,12]
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