Abstract
ObjectivesVarious inflammation-based prognostic scores have been associated with poor survival in patients with hepatocellular carcinoma (HCC), and neutrophils display important roles. However, few studies have illuminated the relationship between preoperative aspartate aminotransferase (AST) to neutrophil ratio index (ANRI) and poor prognosis of HCC. We aimed to clarify the prognostic value of ANRI and evaluate the ability of different inflammation-based prognostic scores such as ANRI, AST to lymphocyte ratio index (ALRI), AST to platelet count ratio index (APRI), neutrophil-lymphocyte ratio index (NLR), and platelet-lymphocyte ratio index (PLR).MethodsData were collected retrospectively from 303 patients who underwent curative resection for HCC. Preoperative ANRI, ALRI, APRI, NLR, PLR and clinico-pathological variables were analyzed. Univariate, multivariate and Kaplan-Meier analyses were performed to identify the predictive value of the above factors for disease-free survival (DFS) and overall survival (OS).ResultsANRI was correlated with presence of HBsAg, AST, presence of cirrhosis, tumor size, PVTT, cancer of the liver Italian program (CLIP) score, recurrence. Univariate analysis showed ANRI, ALRI, APRI, NLR, PLR were significantly associated with DFS and OS in HCC patients with curative resection. After multivariate analysis, ANRI was demonstrated to be superior to ALRI, APRI, NLR, PLR, which were independently correlated with DFS and OS. Survival analysis showed that preoperative ANRI > 7.8 predicted poor prognosis of patients with HCC after hepatectomy. preoperative ANRI also showed different prognostic value in various subgroups of HCC. Furthermore, the predictive range was expanded by the combination of ANRI and NLR.Conclusionspreoperative ANRI is an independent effective predictor of prognosis for patients with HCC, higher levels of ANRI predict poorer outcomes and the combining ANRI and NLR increases the prognostic accuracy of testing.
Highlights
Hepatocellular cancer (HCC) is one of the most common, and most aggressive malignancies, the third leading cause of cancer-related deaths worldwide [1, 2]
In order to improve the outcome of HCC patients, great effort had been made on searching for valid indicators to predict HCC prognosis
As most HCC was the result of chronic liver disease, the outcome of HCC may depends on impaired liver function secondary to the underlying pathogenic condition, rather than solely the tumor burden
Summary
Hepatocellular cancer (HCC) is one of the most common, and most aggressive malignancies, the third leading cause of cancer-related deaths worldwide [1, 2]. The absence of an accurate and sensitive clinical parameter has a profound effect on HCC therapeutic practice. It is very important and urgent to search for an effective preoperative biomarker to identify patients with a high risk of recurrence or metastases, and provide personalized therapy to improve the clinical outcomes. Witjes [9] has reported that the high serum levels of AST may indicate a poor survival in HCC patients. Another factor affects the prognosis is the host’s inflammatory response to cancer and tumor-mediated systemic inflammation [10]. Emerging evidence indicates that neutrophil may reflect the patients’ inflammatory status and downregulate host cellular immunity against cancer, thereby affecting the prognosis [14]
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