Impact of albumin–lymphocyte–platelet–C‐reactive protein index as a prognostic indicator of hepatocellular carcinoma after resection: Associated with nuclear factor erythroid 2–related factor 2

Abstract

AimTo investigate the prognostic value of preoperative albumin‐lymphocyte‐platelet‐c‐reactive protein (ALPC) index in patients with hepatocellular carcinoma (HCC) undergoing curative hepatectomy. We also evaluated with the relationship of the ALPC index and phosphorylated nuclear factor erythroid 2‐related factor 2 (p‐Nrf2) levels.MethodsData were analyzed retrospectively from 256 patients who underwent resection for HCC. For cross‐validation, patients were divided into the training and testing cohort. We assessed eight combinations of inflammatory markers for predictive value for recurrence. We examined the associations of the ALPC index with recurrence‐free survival (RFS) and overall survival (OS) in univariate and multivariate analyses (Cox proportional hazards model). Immunohistochemical staining of p‐Nrf2 was performed on tumor samples of 317 patients who underwent hepatic resection for HCC.ResultsHigh preoperative ALPC index correlated with a high serum albumin concentration, small tumor size, a low rate of poor differentiation, solitary tumor, early Barcelona Clinic Liver Cancer stage and a low rate of microscopic intrahepatic metastasis in the training dataset. High preoperative ALPC index correlated with a high serum albumin concentration, high serum alpha‐fetoprotein concentration, small tumor size, a low rate of poor differentiation and a low rate of microscopic intrahepatic metastasis in the testing dataset. Higher preoperative ALPC index was an independent predictor of longer RFS and OS in the training and testing datasets. High ALPC index was associated with negative p‐Nrf2 expression in HCC tumor cells.ConclusionsWe showed that a high ALPC index was an independent prognostic factor for HCC patients undergoing curative hepatic resection.This article is protected by copyright. All rights reserved.

Impact of inflammation and the immune system on hepatocellular carcinoma recurrence after hepatectomy

“…51 Iseda's another study found that preoperative albumin lymphocyteplatelet-C-reactive protein (ALPC) index was associated with prognostic value in patients undergoing radical hepatectomy for hepatocellular carcinoma (HCC). 52 It found that a high ALPC index was an important predictor of OS and RFS in patients undergoing surgical resection for liver cancer. This may be related to the expression of phosphorylation of antioxidant factor Nrf2 in tumors.…”

“…This may be related to the expression of phosphorylation of antioxidant factor Nrf2 in tumors. 52 A retrospective study from Japan found that the CRP-albumin-lymphocyte index (CALLY index) is a promising biomarker for predicting postoperative outcomes in HCC patients. The study found that patients with low CALLY index (≤5) had better survival and lower recurrence rates after hepatocellular carcinoma resection.…”