Dynamic changes of the inflammation‐based index predict mortality following chemoembolisation for hepatocellular carcinoma: a prospective study

Pinato, David J.; Karamanakos, Georgios; Arizumi, Tadaaki; Adjogatse, D.; Kim, Y. W.; Stebbing, Justin; Kudo, Masatoshi; Jang, Jeong Won; Sharma, Rohini

doi:10.1111/apt.12992

Cited by 31 publications

(23 citation statements)

References 46 publications

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“…Given the utility of CRP in HCC prognostication, Pinato et al utilized the inflammationbased index (IBI), a score derived from CRP and albumin levels, to explore its prognostic ability in post-TACE survival. A higher IBI at baseline demonstrated lower median survival at follow up and a normalization of IBI after TACE remained an independent predictor of better OS (89). Similar data has also been established in RFA for HCC.…”

Section: C-reactive Protein (Crp)supporting

confidence: 76%

Role of inflammatory markers as hepatocellular cancer selection tool in the setting of liver transplantation

Rosenblatt

Tafesh

Halazun

2017

Transl. Gastroenterol. Hepatol.

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Since the advent of the Milan criteria in 1996 and its widespread adoption for selection of patients with hepatocellular carcinoma (HCC) who would benefit from transplant, there has been an extensive hunt for the ideal clinical biomarker to predict HCC recurrence. This is because Milan lack does not include tumor biology indices and recurrence rates remain in the 15-20% range worldwide. While a 'silver-bullet' biomarker has not been found, several useful inflammatory markers have been identified and used in scoring systems that supersede Milan in their ability to predict HCC recurrence post liver transplantation (LT). In this review, we aim to summarize the role of inflammatory markers paly in the selection of HCC patients awaiting LT. measured characteristic to indicate a biological process or response (19). They have the potential to assess the risk of recurrence in HCC without invasive testing, offering yet another tool in a physician's armamentarium to identify the patients who would benefit from LT and those who would not. Currently, several biomarkers are utilized in clinical practice, but both the AASLD and an international consensus (15,20) describe biomarkers as an area of future study. Alpha fetoprotein (AFP) (21)(22)(23)(24) and proteins induced by vitamin K absence II (PIVKA-II) (25-28) have been extensively studied and validated as predictors of HCC outcomes. However, there are patients who do not produce either biomarker and still have high risk of recurrence (29,30). Therefore, pursuing other biomarkers that assess the role of inflammation in malignancy is another method to identify patients at risk of recurrence. The link between inflammation and cancer was postulated in the year 1863 by Virchow, and inflammation has been linked with several gastrointestinal malignancies (31). In the last decade, there has been increasing interest in the use of inflammatory markers as tools to predict poor outcomes in patients with HCC. This review will focus of such inflammatory markers, the role they play in HCC, and how to potentially use these as selection tools for patients awaiting transplant. Neutrophil lymphocyte ratio (NLR)The NLR is a measure of the proportion of peripheral blood neutrophils to lymphocytes and has an important role in predicting outcomes in several malignancies. An elevated NLR can be a marker of both neutrophilia in response to inflammation or peripheral lymphopenia, both first demonstrated the use of NLR in predicting outcomes for HCC in 150 patients undergoing LT for HCC. Of the 13 patients with elevated NLR, 62% had recurrence and, as a cohort, had significantly worse OS and RFS. Of note, even patients within Milan criteria with an elevated NLR, compared to those with normal NLR, had a significantly worse survival (30% vs. 81%) (36). In the largest study in the MELD era from the United States examining post-LT outcomes for HCC, the MORAL score was evaluated for its ability to predict post-LT RFS. The MORAL score was constructed using Cox-regression analyses for factors imp...

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Section: C-reactive Protein (Crp)supporting

confidence: 76%

Role of inflammatory markers as hepatocellular cancer selection tool in the setting of liver transplantation

Rosenblatt

Tafesh

Halazun

2017

Transl. Gastroenterol. Hepatol.

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“…Levels of at least 10 mg/L were comparative to invasion of the vascular system [odds ratio (OR) = 3.05], tumor growth (OR = 2.36), increasing size (OR = 3.41) and advanced stage (OR = 3.23) [43] . Based on these various findings a score has been proposed that is a combination of elevated CRP and low albumin levels, known as the Inflammationbased index [44] .…”

Section: Tumor Markers As Criteria For Hccmentioning

confidence: 99%

Hepatocellular carcinoma: A comprehensive review

Waller

Deshpande

Pyrsopoulos

2015

WJH

174

123

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chronic hepatitis B and C infections are most commonly afflicted. Different therapeutic options, including liver resection, transplantation, systemic and local therapy, must be tailored to each patient. Liver transplantation offers leading results to achieve a cure. The Milan criteria is acknowledged as the model to classify the individuals that meet requirements to undergo transplantation. Mean survival remains suboptimal because of long waiting times and limited donor organ resources. Recent debates involve expansion of these criteria to create options for patients with HCC to increase overall survival.

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“…In addition to underlying liver dysfunction in HCC, systemic inflammation seems to play an equally relevant role in influencing albumin levels . Hence, by modulating the underlying inflammatory response, anticancer therapies have been found to exert a positive effect on albumin levels . In contrast, it remains unclear whether increased CRP secretion promotes tumorigenesis or is merely an innocent bystander that happens to sit downstream of excess systemic cytokine release.…”

Section: Introductionmentioning

confidence: 99%

The systemic inflammatory response as a source of biomarkers and therapeutic targets in hepatocellular carcinoma

Sanghera

Teh

Pinato

2019

Liver International

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The pathogenesis of hepatocellular carcinoma (HCC) strongly relates to inflammation, with chronic up‐regulation of pro‐inflammatory mediators standing as a potential unifying mechanism that underscores the origin and progression of HCC independent of aetiology. Activation of the diverse pro‐inflammatory mediators either within the tumour or its microenvironment is part of an active cross‐talk between the progressive HCC and the host, which is known to influence clinical outcomes including recurrence after radical treatments and long‐term survival. A number of clinical biomarkers to measure the severity of cancer‐related inflammation are now available, most of which emerge from routine blood parameters including neutrophil, lymphocyte, platelet counts, as well as albuminaemia and C‐reactive protein levels. In this review, we summarise the body of evidence supporting the biologic qualification of inflammation‐based scores in HCC and review their potential in facilitating the prognostic assessment and treatment allocation in the individual patient. We also discuss the evidence to suggest modulation of tumour‐promoting inflammation may act as a source of novel therapeutic strategies in liver cancer.

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Dynamic changes of the inflammation‐based index predict mortality following chemoembolisation for hepatocellular carcinoma: a prospective study

Cited by 31 publications

References 46 publications

Role of inflammatory markers as hepatocellular cancer selection tool in the setting of liver transplantation

Role of inflammatory markers as hepatocellular cancer selection tool in the setting of liver transplantation

Hepatocellular carcinoma: A comprehensive review

The systemic inflammatory response as a source of biomarkers and therapeutic targets in hepatocellular carcinoma

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