Inflammation Score System using Preoperative Inflammatory Markers to Predict Prognosis for Hepatocellular Carcinoma after Hepatectomy: A Cohort Study

Abstract

Background: This study developed a novel inflammation score system to predict survival outcomes using preoperational inflammatory markers in hepatocellular carcinoma (HCC) after surgery. Materials and Methods: An inflammation score system was developed using five preoperative inflammatory markers based on the clinical data of 455 HCC patients (training cohort) receiving radical resection in the Eastern Hepatobiliary Surgery Hospital. The system was validated using a cohort from a different hospital (external validation). Kaplan-Meier curves and log-rank test were used to compare the survival of patients with different inflammation scores. A nomogram including inflammation scores for survival prediction was created to exhibit the risk factors of overall survival (OS). Results: The patients in the low-score group showed better OS and recurrence-free survival (RFS) in the training and external validation cohorts than those from the high-score group. Subgroup analysis showed that compared with patients in the training cohort from the high-score group, stage I (eighth TNM stage) patients in the low-score group exhibited better prognosis results, whereas the findings for Stage II and III patients were different. Multivariate Cox analysis revealed that high inflammation score is an independent risk factor of OS and RFS. The nomogram established using the inflammation score with the C-index value of 0.661 (95% confidence interval=0.624-0.698) revealed a good three- and five-year calibration curves. Conclusions: The inflammation score system based on five preoperative inflammatory markers well predicted the survival of HCC patients after surgery, especially in those at the early stage (Stage I).

Albumin-Bilirubin (ALBI) and Monocyte to Lymphocyte Ratio (MLR)-Based Nomogram Model to Predict Tumor Recurrence of AFP-Negative Hepatocellular Carcinoma

“… 27 The immune microenvironment and inflammatory markers are all parts of the systemic inflammatory response and play an important role in cancer development, progression, invasion, and metastasis. 28 , 29 The present study first confirmed that the MLR could be used to determine the recurrence of AFP-negative HCC patients after curative resection. As a systemic inflammatory marker in the peripheral blood, the MLR is low in cost of examination and simple to calculate by monocytes and lymphocytes and can be measured repeatedly.…”

Transcription factor E2F4 is an indicator of poor prognosis and is related to immune infiltration in hepatocellular carcinoma

“…Current treatment strategies such as resection, chemotherapy, radiation, immunotherapy, and gene therapy are improving, but recurrence of illness due to therapy resistance results in high mortality. And the five-year recurrence rate after resection is up to 60% to 70% 30 . Most HCC patients suffer from a clinically poor prognosis 31 .…”

The Value of Preoperative Systemic Inflammatory Response index (SIRI) Combined with Albumin-Bilirubin Grading (ALBI) in Predicting Early Recurrence Following Curative Resection of Single Hepatocellular Carcinoma

“…The potential mechanisms could be that neutrophils are mainly concentrated in the peritumoral matrix of liver cancer tissues, [32] and can release angiogenic factors and in ammatory mediators, such as interleukin-1 β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and reactive oxygen species (ROS). In addition, neutrophils can inhibit the cytolytic activity of immune cells, which promotes the proliferation and metastasis of cancer cells [5,9,10,31,33]. Neutrophils and tumor-associated macrophages modulate the suppression of anti-tumor immunity by inhibiting the immune function of natural killer cells and T cells, leading to malignant progression [5].…”

“…The majority of HCC cases occur in the context of hepatitis and cirrhosis; therefore, in ammation is particularly signi cant in the process of its occurrence and development. Preoperative scoring systems based on peripheral in ammatory indicators, such as NLR, MLR, and PLR, have also been proven to be associated with the prognosis of HCC [5,9,10]. In 2016, Qi proposed a new in ammatory index based on peripheral blood lymphocytes, neutrophils, and monocytes, namely SIRI [11], and it has been proven to predict the prognosis of various malignant tumors, such as pancreatic cancer, cervical cancer, esophageal cancer of the stomach, and breast cancer [12][13][14]; however, its prognostic value in HCC has not been studied.…”

“…Tumor-related in ammation and immune responses are essential for the occurrence, development, angiogenesis, and metastasis of malignant tumors [8]. Several studies have shown that preoperative scores based on routine blood in ammatory indicators, such as neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR), affect the prognosis of HCC [5,9,10]. In 2016, Qi proposed a new in ammatory index based on peripheral blood lymphocytes, neutrophils, and monocytes, namely the systemic in ammatory response index (SIRI), which has been proven to predict the prognosis of many types of malignant tumors, such as pancreatic cancer, cervical cancer, esophageal gastric cancer, and breast cancer [11][12][13][14].…”