Systemic Hepatic-Damage Index for Predicting the Prognosis of Hepatocellular Carcinoma after Curative Resection.

Xing-Hui Gao,Shuang-Shuang Zhang,Fu-Bing Wang,Hao Chen,Chun-Hui Yuan,Yu-Hui Wang

doi:10.3389/fphys.2017.00480

Abstract

Purpose: We have developed a systemic hepatic-damage index (SHI) based on serum total cholesterol (TC) and high density lipoprotein levels (HDL) and determined its prognostic significance in hepatocellular carcinoma (HCC) patients undergoing resection.Experimental Design: The SHI was analyzed in the training cohort of 188 HCC patients and in the validation cohort of 177 HCC patients. The systemic immune-inflammation index (SII) scores in the validation cohorts were also measured. Area under the receiver operating characteristic curve (AUC) was used to explore the prediction accuracy in HCC patients.Results: An optimal cutoff point for the SHI of 2.84 stratified the HCC patients into high SHI (>2.84) and low SHI (≤2.84) groups in the training cohort. Univariate and multivariate analyses revealed the SHI was an independent predictor for overall survival and relapse-free survival, and prognostic for patients with negative α-fetoprotein and Barcelona Clinic Liver Cancer stage 0+A. The AUCs of the SHI for survival and recurrence were higher than other conventional clinical indices. Low SHI significantly correlated with vascular invasion. The SII scores were significantly higher in patients with low SHI compared with those with high SHI. HCC patients in SHI ≤ 2.84 group had shorter recurrence time and lower survival rate than HCC patients in SHI > 2.84 group.Conclusions: The SHI was a potential biomarker for assessing HCC prognosis, and improving SHI level in HCC patients may be a promising therapeutic strategy decision. The poor outcome in HCC patients with low SHI scores might increase SII scores, increasing the possibility of recurrence and metastasis.

Highlights

MATERIALS AND METHODSHepatocellular carcinoma (HCC) is the most common malignancy with an increasing mortality rate worldwide
E Specialty section: R This article was submitted to Purpose: We have developed a systemic hepatic-damage index (SHI) based on serum total cholesterol (TC) and high density lipoprotein levels (HDL) and determined its prognostic significance in hepatocellular carcinoma (HCC) patients undergoing resection
Univariate and multivariate analyses revealed the SHI was an independent predictor for overall survival and relapse-free survival, and prognostic for patients with negative α-fetoprotein and Barcelona Clinic Liver Cancer stage 0+A

Summary

Introduction

Hepatocellular carcinoma (HCC) is the most common malignancy with an increasing mortality rate worldwide. Surgical resection remains the most effective treatment for HCC patients; the prognosis of HCC patients who underwent curative resection remains unsatisfactory because of high recurrence possibility and metastasis incidence (Ji et al, 2009; Forner et al, 2012; Torre et al, 2015). The utility of conventional clinicopathological parameters, including histopathological characteristics, is insufficient for identifying patient subpopulations at high risk of tumor recurrence and metastasis. It is urgent to develop new biomarkers for identifying tumor recurrence and metastasis so that post-operative rational adjuvant treatments can be provided timely. The reasons for the high recurrence/metastasis rate in HCC

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Conclusion