Nomogram Based on Systemic Immune Inflammation Index and Prognostic Nutrition Index Predicts Recurrence of Hepatocellular Carcinoma After Surgery

Abstract

Background Surgery is a potential cure for hepatocellular carcinoma (HCC), but its postoperative recurrence rate is high, its prognosis is poor, and reliable predictive indicators are lacking. This study was conducted to develop a simple, practical, and effective predictive model. Materials and Methods Preoperative clinical and postoperative pathological data on patients with HCC undergoing partial hepatectomies at the Third Affiliated Hospital of Soochow University from January 2010 to December 2015 were retrospectively analyzed, and a nomogram was constructed. The model performance was evaluated using C-indexes, receiver operating characteristic curves, and calibration curves. The results were verified from validation cohort data collected at the same center from January 2016 to January 2017 and compared with the traditional staging systems. Results Three hundred three patients were enrolled in this study: 238 in the training cohort and 65 in the validation cohort. From the univariate and multivariate Cox regression analyses in the training cohort, six independent risk factors, i.e., age, alpha-fetoprotein (AFP), tumor size, satellite nodules, systemic immune inflammation index (SII), and prognostic nutritional index (PNI), were filtered and included in the nomogram. The C-index was 0.701 [95% confidence interval (CI): 0.654–0.748] in the training cohort and 0.705 (95% CI: 0.619–0.791) in the validation cohort. The areas under the curve for the 1- and 3-year recurrence-free survival were 0.706 and 0.716 in the training cohort and 0.686 and 0.743 in the validation cohort, respectively. The calibration curves showed good agreement. Compared with traditional American Joint Committee on Cancer 8th edition (AJCC8th) and Barcelona Clinic Liver Cancer (BCLC) staging systems, our nomogram showed better predictive ability. Conclusion Our nomogram is simple, practical, and reliable. According to our nomogram, predicting the risk of recurrence and stratifying HCC patient management will yield the greatest survival benefit for patients.

Intraoperative low-dose dopamine is associated with worse survival in patients with hepatocellular carcinoma: A propensity score matching analysis

“…Despite the improvement of therapeutic strategies and surveillance plans, the postoperative recurrence rate of HCC is still high and strongly associated with poor prognosis. A series of studies have reported that AFP levels and satellite nodules are related to worse survival of liver cancer patients (25)(26)(27). These results were similar in our study.…”

Predictive Value of Preoperative Serum AFP, CEA, and CA19-9 Levels in Patients with Single Small Hepatocellular Carcinoma: Retrospective Study

“…Tumor differentiation has been used to predict the prognosis of malignant tumors; however, recent studies revealed the lack of significant prognosis effect of tumor differentiation. 39 , 40 Several serum markers, such as prognostic nutritional index, 41 rapid turnover proteins (RTPs), 42 and some inflammation indicators, like systemic immune inflammation index (SII), 43 neutrophil-to-lymphocyte ratio (NLR), 44 lymphocyte-to-monocyte ratio (LMR), 45 and platelet-to-lymphocyte ratio (PLR) were found to contribute to tumor progression. 46 However, only a few studies compared AUC with other prognostic systems, such as TNM stage and Child-Pugh classification.…”

Prognostic significance of systemic immune-inflammation index and platelet-albumin-bilirubin grade in patients with pancreatic cancer undergoing radical surgery

“…However, the value of known biomarkers in prognosis of PC is still controversial. The systemic immune-inflammation index (SII), a systemic inflammatory marker based on the counts of platelets (PLTs), neutrophils, and lymphocytes, has been linked to the outcomes of melanoma patients (5,6) and subsequently confirmed in patients with hepatocellular carcinoma (7)(8)(9)(10) and lung cancer (5). High SII is associated with shorter overall survival (OS) (11,12).…”