Platelet-to-hemoglobin ratio to predict progression-free survival for patients with locally advanced hepatocellular carcinoma.

Abstract

463 Background: The prognosis of locally advanced hepatocellular carcinoma (HCC) patients is far from being identified which makes the treatment decision controversial. The present study aimed to assess role of blood cell counts, routine liver function tests in predicting the progression-free survival (PFS) of these patients. Methods: A total of 243 HCC patients staged Barcelona Clinic Liver Cancer (BCLC) B or C were analyzed retrospectively. The current staging systems of HCC were investigated about their performance on predicting PFS. And then, the novel prognostic factors were evaluated by integrating in to the best staging systems which was used to determine their independent prognostic value. Results: Cancer of the liver Italian program (CLIP) score system and advanced liver cancer prognostic system (ALCPS) stages were indentified to be testing systems with best akaike information criterion (AIC) index and linear trend χ2 among all the current 12 staging systems for this patient subgroup. Then, the prognostic value of novel parameters was assessed by integration into CLIP and ALCPS score systems. Platelet-to-Hemoglobin Ratio (PHR) were confirmed to an independent predictor for PFS of locally advanced HCC patients when integrated into CLIP and ALCPS score systems ( p= 0.026 and 0.009, respectively) with the other parameters, including platelet and hemoglobin, failed to reach statistical significance. Moreover, PHR improved the performance of CLIP and ALCPS score systems by adjusted into it, which improved their discriminatory ability. Furthermore, PHR were designated ≤ 1.26 as low level and > 1.26 as high level, according to which HCC patients were dichotomized into two groups. Locally advanced HCC patients with low PHR presented better 1 year disease progress rate (24.0% vs 41%) and overall survival (62.5% vs 38.8%) compared with patients with high PHR level. Besides, PHR level was associated with prognostic factors such as international normalized ratio, presence of ascites, serum albumin, serum α-fetoprotein, total bilirubin and portal vein thrombosis. Conclusions: The present study firstly indentified PHR as an independent prognostic factor in locally advanced HCC patients.