Abstract
BackgroundThe prognosis of hepatocellular carcinoma (HCC) is not optimistic. Our study focused on present inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), gamma-glutamyl transpeptidase-to-platelet ratio (GPR), aspartate aminotransferase-to-lymphocyte ratio (ALR) and fibrinogen-to-albumin ratio (FAR), and explored their optimal combination for the prognosis of HCC after resection.MethodsA total of 347 HCC patients who underwent curative resection were enrolled. The optimal cutoff values of the inflammatory markers were calculated using receiver operating characteristic (ROC) curve analysis, and used to divide patients into two groups whose differences were compared by Kaplan–Meier analysis. Cox univariate and multivariate analyses were used to analyze the independent prognostic inflammatory markers. The χ2 test was chosen to determine the relationship between independent prognostic inflammatory markers and clinicopathological features. We created combined scoring models and evaluated them by Cox univariate and multivariate methods. The concordance index (C-index), Akaike information criterion (AIC) and likelihood ratio were calculated to compare the models. The selected optimal inflammatory markers and their combinations were tested in different stages of HCC by Kaplan–Meier analysis.ResultsThe ALR and GPR were independent prognostic factors for disease-free survival (DFS); the ALR, PLR, and GPR were independent prognostic factors for overall survival (OS). The proposed GPR and ALR-GPR-PLR score models were independent predictors for DFS and OS, respectively.ConclusionThe preoperative GPR and ALR-GPR-PLR score models were independent predictors for DFS and OS, respectively, and performed well in stratifying patients with HCC. The higher the score in the model was, the worse the prognosis.
Highlights
The prognosis of hepatocellular carcinoma (HCC) is not optimistic
Our study focused on comparing the effects of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), glutamyl transpeptidase-to-platelet ratio (GPR), aminotransferase-to-lymphocyte ratio (ALR) and fibrinogen-to-albumin ratio (FAR) on the prognosis of HCC patients who had undergone liver resection, to find the optimal combination and to establish models that can accurately predict prognosis
9 patients with Barcelona Clinic Liver Cancer (BCLC) stage 0 were merged into the BCLC stage A group, and 5 patients with American Joint Committee on Cancer (AJCC) stage IV were merged into the AJCC stage III group (Table 1)
Summary
The prognosis of hepatocellular carcinoma (HCC) is not optimistic. Our study focused on present inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), gamma-glutamyl transpeptidase-to-platelet ratio (GPR), aspartate aminotransferase-to-lymphocyte ratio (ALR) and fibrinogen-to-albumin ratio (FAR), and explored their optimal combination for the prognosis of HCC after resection. Liver resection is still the mainstay of treatments for HCC patients. The Barcelona Clinic Liver Cancer (BCLC) staging system, including recommendations for treatments, has been widely validated and is the most frequently used staging method [5, 6]. The American Joint Committee on Cancer (AJCC) and China Liver Cancer (CNLC) staging systems are commonly considered [7, 8]. These staging systems have some limitations due to the heterogeneity of tumors. Plasma alpha-fetoprotein (AFP) levels, a common tumor marker for HCC, remain within the normal range in 15–30% of advanced HCC patients [9]. More efficient prognostic indicators need to be explored to conduct active interventions to improve survival rates
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