Novel Prognostic Nomograms Based on Inflammation-Related Markers for Patients with Hepatocellular Carcinoma Underwent Hepatectomy
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Purpose Hepatocellular carcinoma (HCC) is an aggressive disease with high recurrence rate. However, current staging systems were lack of predictive capacity for HCC recurrence. We aimed to develop prognostic nomograms based on inflammation-related markers for HCC patients underwent hepatectomy. Materials and Methods We recruited 889 surgically treated patients from two medical centers. Independent prognostic factors were identified by cox regression analyses. Nomograms for recurrence-free survival (RFS) and overall survival (OS) were established and validated internally and externally. The performance, discrimination, and calibration of nomograms were assessed and compared with existed staging systems. Results Neutrophil to lymphocyte ratio (NLR) and gamma-glutamyl transpeptidase to platelet ratio (GPR) were the two inflammation-related factor that independently correlated with survival. NLR, GPR, international normalized ratio (INR), microvascular invasion, satellite lesions, tumor number, tumor diameter, and macrovascular invasion were used to construct nomogram for RFS while GPR, total bilirubin, INR, -fetoprotein, microvascular invasion, satellite lesions, tumor diameter, and macrovascular invasion were for OS. In the training cohort, the C-index of nomogram was 0.701 (95% confidence interval [CI], 0.669 to 0.732) for RFS and 0.761 (95% CI, 0.728 to 0.795) for OS. These results received both internal and external validation with C-index of 0.701 (95% CI, 0.647 to 0.755) and 0.707 (95% CI, 0.657 to 0.756) for RFS, and 0.706 (95% CI, 0.640 to 0.772) and 0.708 (95%CI, 0.646 to 0.771) for OS, respectively. The nomograms showed superior accuracy to conventional staging systems (p < 0.001). Conclusion The nomograms based on inflammation-related markers are of high efficacy in predicting survival of HCC patients after hepatectomy, which will be valuable in guiding postoperative interventions and follow-ups.
Abstract
Purpose Hepatocellular carcinoma (HCC) is an aggressive disease with high recurrence rate. However, current staging systems were lack of predictive capacity for HCC recurrence. We aimed to develop prognostic nomograms based on inflammation-related markers for HCC patients underwent hepatectomy. Materials and Methods We recruited 889 surgically treated patients from two medical centers. Independent prognostic factors were identified by cox regression analyses. Nomograms for recurrence-free survival (RFS) and overall survival (OS) were established and validated internally and externally. The performance, discrimination, and calibration of nomograms were assessed and compared with existed staging systems. Results Neutrophil to lymphocyte ratio (NLR) and gamma-glutamyl transpeptidase to platelet ratio (GPR) were the two inflammation-related factor that independently correlated with survival. NLR, GPR, international normalized ratio (INR), microvascular invasion, satellite lesions, tumor number, tumor diameter, and macrovascular invasion were used to construct nomogram for RFS while GPR, total bilirubin, INR, -fetoprotein, microvascular invasion, satellite lesions, tumor diameter, and macrovascular invasion were for OS. In the training cohort, the C-index of nomogram was 0.701 (95% confidence interval [CI], 0.669 to 0.732) for RFS and 0.761 (95% CI, 0.728 to 0.795) for OS. These results received both internal and external validation with C-index of 0.701 (95% CI, 0.647 to 0.755) and 0.707 (95% CI, 0.657 to 0.756) for RFS, and 0.706 (95% CI, 0.640 to 0.772) and 0.708 (95%CI, 0.646 to 0.771) for OS, respectively. The nomograms showed superior accuracy to conventional staging systems (p < 0.001). Conclusion The nomograms based on inflammation-related markers are of high efficacy in predicting survival of HCC patients after hepatectomy, which will be valuable in guiding postoperative interventions and follow-ups.
참고문헌 (30)
- Bray F, "Global cancer statistics 2018 : GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries", CA Cancer J Clin, 68, pp.394~424 (2018)
- Portolani N, "Early and late recurrence after liver resection for hepatocellular carcinoma : prognostic and therapeutic implications", Ann Surg, 243, pp.229~235 (2006)
- European Association for the Study of the Liver, "EASL clinical practice guidelines : management of hepatocellular carcinoma", J Hepatol, 69, pp.182~236 (2018)
- de Martel C, "Global burden of cancers attributable to infections in 2008 : a review and synthetic analysis", Lancet Oncol, 13, pp.607~615 (2012)
- Mantovani A, "Cancer-related inflammation", Nature, 454, pp.436~444 (2008)
- Trepo C, "Hepatitis B virus infection", Lancet, 384, pp.2053~2063 (2014)
- Berasain C, "Inflammation and liver cancer : new molecular links", Ann N Y Acad Sci, 1155, pp.206~221 (2009)
- Sasaki A, "Prognostic value of preoperative peripheral blood monocyte count in patients with hepatocellular carcinoma", Surgery, 139, pp.755~764 (2006)
- Gomez D, "Preoperative neutrophil-to-lymphocyte ratio as a prognostic predictor after curative resection for hepatocellular carcinoma", World J Surg, 32, pp.1757~1762 (2008)
- Smith RA, "Preoperative platelet-lymphocyte ratio is an independent significant prognostic marker in resected pancreatic ductal adenocarcinoma", Am J Surg, 197, pp.466~472 (2009)
- Lin ZX, "Lymphocyte-to-monocyte ratio predicts survival of patients with hepatocellular carcinoma after curative resection", World J Gastroenterol, 21, pp.10898~10906 (2015)
- Wang WL, "Preoperative gamma-glutamyl transpeptidase to platelet ratio (GPR) is an independent prognostic factor for HBV-related hepatocellular carcinoma after curative hepatic resection", Medicine (Baltimore), 95, pp.e4087~ (2016)
- Chan AW, "Prognostic Nutritional Index(PNI)predicts tumor recurrence of very early", early stage hepatocellular carcinoma after surgical resection, 2015, pp.22, 4138~4148
- Yang Z, "Aspartate aminotransferase-lymphocyte ratio index and systemic immune-inflammation index predict overall survival in HBV-related hepatocellular carcinoma patients after transcatheter arterial chemoembolization", Oncotarget, 6, pp.43090~43098 (2015)
- Shen SL, "Preoperative aspartate aminotransferase to platelet ratio is an independent prognostic factor for hepatitis B-induced hepatocellular carcinoma after hepatic resection", Ann Surg Oncol, 21, pp.3802~3809 (2014)
- Ji F, "Prognostic significance of preoperative aspartate aminotransferase to neutrophil ratio index in patients with hepatocellular carcinoma after hepatic resection", Oncotarget, 7, pp.72276~72289 (2016)
- Pinato DJ, "A novel and validated prognostic index in hepatocellular carcinoma : the inflammation based index(IBI)", J Hepatol, 57, pp.1013~1020 (2012)
- Hu B, "Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma", Clin Cancer Res, 20, pp.6212~6222 (2014)
- Shim JH, "Prognostic nomograms for prediction of recurrence and survival after curative liver resection for hepatocellular carcinoma", Ann Surg, 261, pp.939~946 (2015)
- Yang P, "Nomograms for pre-and postoperative prediction of long-term survival for patients who underwent hepatectomy for multiple hepatocellular carcinomas", Ann Surg, 263, pp.778~786 (2016)
- Shen J, "Prognostic nomograms for patients with resectable hepatocelluar carcinoma incorporating systemic inflammation and tumor characteristics", Oncotarget, 7, pp.80783~80793 (2016)
- He W, "Nomogram to predict survival of patients with recurrence of hepatocellular carcinoma after surgery", Clin Gastroenterol Hepatol, 16, pp.756~764 (2018)[DOI]
- Strasberg SM, "Nomenclature of hepatic anatomy and resections : a review of the Brisbane 2000 system", J Hepatobiliary Pancreat Surg, 12, pp.351~355 (2005)
- Shi J, "Surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus", Ann Surg Oncol, 17, pp.2073~2080 (2010)
- European Association For the Study of the Liver, "EASLEORTC clinical practice guidelines: management of hepatocellular carcinoma", J Hepatol, 56, pp.908~943 (2012)
- Pinato DJ, "A novel, externally validated inflammation-based prognostic algorithm in hepatocellular carcinoma : the prognostic nutritional index(PNI)", Br J Cancer, 106, pp.1439~1445 (2012)
- Lemoine M, "The gamma-glutamyl transpeptidase to platelet ratio(GPR)predicts significant liver fibrosis and cirrhosis in patients with chronic HBV infection in West Africa", Gut, 65, pp.1369~1376 (2016)
- Imamura H, "Risk factors contributing to early and late phase intrahepatic recurrence of hepatocellular carcinoma after hepatectomy", J Hepatol, 38, pp.200~207 (2003)
- Kluger MD, "Liver resection for hepatocellular carcinoma in 313 Western patients : tumor biology and underlying liver rather than tumor size drive prognosis", J Hepatol, 62, pp.1131~1140 (2015)
- Zhong JH, "Hepatic resection associated with good survival for selected patients with intermediate and advanced-stage hepatocellular carcinoma", Ann Surg, 260, pp.329~340 (2014)