Abstract
Increasing evidence indicates that preoperative prognostic indices can serve as independent predictors of survival in patients with cancer. However, the applicability of these indices in patients with hepatocellular carcinoma (HCC) is controversial. This study aims to investigate the prognostic value of these indices in patients with HCC after curative hepatectomy. We retrospectively analyzed the data of 215 patients who underwent curative resection for HCC. Prognostic indices including prognostic nutritional index (PNI) and neutrophil-to-lymphocyte ratio (NLR) were evaluated by comparing by the area under the curve (AUC). Univariate analysis and multivariate analysis were performed to identify independent prognostic factors. Additionally, risk factors were combined to predict the survival of patients. We found that serum albumin concentration, tumor diameter, tumor stage, degree of differentiation, PNI, and NLR were independent prognostic factors for overall survival (OS). Vascular invasion, tumor stage, degree of differentiation, and PNI were independent prognostic factors for recurrence-free survival (RFS). The cutoff value of the PNI and NLR was 43.75 and 3.29, respectively. Patients with low NLR and high PNI had the best outcomes, potentially indicative of the intensive antitumor effects of the immune system. Moreover, patients with at least three risk factors had a significantly lower OS and RFS compared with those with two or fewer risk factors. This new nomogram based on PNI and NLR may provide an accessible and individualized prediction of survival and recurrence for HCC patients.
Highlights
Hepatocellular carcinoma (HCC) is one of the most common cancers with the mortality rate ranking fifth among men and eighth among women [1]
A prognostic nutritional index (PNI) of 43.75 with a sensitivity of 74.5% and a specificity of 78.2% was chosen as the best cutoff point for 5-year overall survival (OS), and the area under the curve (AUC) was 0.592
Correlation analysis of our study proved that a low PNI was significantly associated with older age, higher Child–Pugh grade, more intraoperative blood loss, worse degree of tumor differentiation, and higher recurrence rate (p < 0.05)
Summary
Hepatocellular carcinoma (HCC) is one of the most common cancers with the mortality rate ranking fifth among men and eighth among women [1]. As the survival of patients who received potentially curative treatment remains poor, risk factors for postoperative survival should be determined to personalize therapies and improve clinical outcomes. The previous studies have been reported that the PNI was a prognostic factor for evaluating short- and long-term outcomes after liver resection in HCC patients [9] and preoperative PNI predicts prognosis after curative hepatectomy in early Barcelona clinic liver cancer (BCLC) stage HCC [11]. In the present study, we further explore the correlation between PNI and other series of prognostic indicators and clinical features; in addition, we aimed to combine two or more risk factors to better predict the prognosis of HCC patients after hepatectomy
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