The Prognostic Value of aspartate aminotransferase to lymphocyte ratio and systemic immune-inflammation index for Overall Survival of Hepatocellular Carcinoma Patients Treated with palliative Treatments

Abstract

Background : Lymphocytes were reported to play a significant part in host anticancer immune responses and influence tumour prognosis. Few studies have focused on the prognostic values of aspartate aminotransferase (AST) to lymphocyte ratio (ALRI), aspartate aminotransferase to platelet count ratio index (APRI) and systemic immune-inflammation index (SII) in hepatocellular carcinoma (HCC) treated with palliative treatments. Methods : Five hundred and ninety-eight HCC patients treated with palliative therapies were retrospectively analysed. We randomly assigned patients into the training cohort (429 patients) and the validation cohort I (169 patients). Receiver operating characteristic (ROC) curves were used to identify the best cut-off values for the ALRI, APRI and SII in the training cohort and the values were further validated in the validation cohort I. Correlations between ALRI and other clinicopathological factors were also analysed. A prognostic nomogram including ALRI was established. We validated the prognostic value of the ALRI, SII and APRI with two independent cohorts, the validation cohort II of 82 HCC patients treated with TACE and the validation cohort III of 150 HCC patients treated with curative resection. In the training cohort and all the validation cohorts, univariate analyses by the method of Kaplan-Meier and multivariate analysis by Cox proportional hazards regression model were carried out to identify the independent prognostic factors. Results : The threshold values of ALRI, APRI and SII were 86.3, 1.37 and 376.4 respectively identified by ROC curve analysis in the training cohort. Correlation analysis showed that ALRI>86.3 was greatly associated with higher rates of Child-Pugh B&C, portal vein tumor thrombosis (PVTT) and ascites ( P < 0.05). Correspondingly, ALRI level of HCC patients with Child-Pugh B&C, PVTT and ascites was evidently higher than that of HCC patients with Child-Pugh A, without PVTT and without ascites ( P < 0.001). In the training cohort and the validation cohort I, II, III, the OS of patients with ALRI >86.3 was obviously shorter than patients with ALRI ≤86.3 ( P < 0.001). We identified ALRI as an independent prognostic factor by univariate and multivariate analyses both in training Cohort (HR=1.481, P= 0.004), validation cohort I (HR=1.511, P= 0.032), validation cohort II (HR=3.166, P= 0.005) and validation cohort III (HR=3.921, P= 0.010). The SII was identified as an independent prognostic factor in training cohort (HR=1.356, P= 0.020) and the validation cohort II (HR=2.678, P= 0.002). The prognostic nomogram including ALRI was the best in predicting 3-month, 6-month, 1-year, 2-year survival And OS among TNM, ALRI, ALRI-TNM and nomogram. Conclusions : The ALRI was a novel indep...

Systemic immune inflammation index is a promising non-invasive marker for the prognosis of the patients with localized renal cell carcinoma

“…However, beyond these markers, which calculate only two immune cells, a novel index, SII, is based on three peripheral blood cells, including platelet, neutrophil, and lymphocyte. SII has been reported to be a more objective index with better predictive reliability for prognosis, reflecting the host immune status more comprehensively in various types of cancers [18][19][20][21][22][23][24].…”

<p>Pretreatment Systemic Inflammation Response Index in Patients with Breast Cancer Treated with Neoadjuvant Chemotherapy as a Useful Prognostic Indicator</p>

“…Various studies have shown that tumors are associated to systemic inflammation. [27][28][29] However, the mechanisms between tumors and inflammation reaction are yet ambiguous and poorly understood. Some studies have suggested that systemic inflammatory cells, such as neutrophils, monocytes, platelets, and lymphocytes, are linked to prognosis of many malignancies.…”

Development of an ALBI and ascites based model to predict survival for BCLC Stage B hepatocellular carcinoma

“…Ascites are the most common rst symptom of liver decompensation, which seriously affects the prognosis of patients with cirrhosis (13). The ascites were evaluated to be independent risk factor for the survival of HCC patients, and has been incorporated into several HCCrelated risk models (13,14,16,18). Therefore there might be an over-simpli cation in the ALBI grade, and the ascites could be retained as the parameters for the assessing of the liver function.…”

“…And the ascites always predicted the prognosis more accurately than the albumin level in previous HCC related risk models. Additionally, the ascites have been incorporated into several HCC-related prognostic model (such as HCC with portal vein tumor thrombus, HCC after ablation, HCC after palliative treatments, and BCLC stage C HCC) (14)(15)(16)(17)(18). Therefore it appears arbitrary and crude that eliminating the ascites variable from the risk prediction model for BCLC stage B HCC patients.…”