Verification of inflammation‐based prognostic marker as a prognostic indicator in hepatocellular carcinoma

Abstract

AimAlthough inflammation‐based markers in cancer have been used for prognostic prediction, the most useful marker for hepatocellular carcinoma (HCC) has not been established. We investigated the usefulness of various inflammation‐based markers in HCC patients after hepatectomy.MethodsA total of 478 patients who underwent initial hepatectomy for HCC from 2009 to 2015 and were diagnosed with pathological HCC were included in this retrospective study. Inflammation‐based markers consisted of the C‐reactive protein to albumin ratio (CAR), Glasgow prognostic score (GPS), neutrophil to lymphocyte ratio, lymphocyte to monocyte ratio, platelet to lymphocyte ratio and prognostic index. Univariate and multivariate analyses for overall survival (OS) and disease‐free survival (DFS) using the Cox proportional hazard model were carried out. Kaplan‐Meier analysis and log‐rank test were used for comparison of OS and DFS. To reduce influences of selection bias and confounders for stratifying CAR, clinicopathological characteristics of patients were balanced by propensity score matching.ResultsMultivariate analysis identified only high CAR (>0.027) as an indicator of poor OS, and high CAR and high GPS (1‐2) as indicators of poor DFS among inflammation‐based markers. After propensity score matching, 124 patients each with low CAR and high CAR were matched. High CAR was correlated with both poor OS and DFS.ConclusionC‐reactive protein to albumin ratio was the most valuable prognostic indicator after hepatectomy for HCC among inflammation‐based markers.

<p>Inflammation-Based Prognostic Scores in Patients with Hepatitis B Virus-Related Hepatocellular Carcinoma After Liver Transplantation</p>

“…[4][5][6] There is increasing evidence that correlates preoperative immunological statuses with not only postoperative complications but also long-term outcomes of patients with certain tumors, which is associated with poorer cancer-specific survival in patients with malignant tumors. [7][8][9] In addition, a growing number of studies have shown that circulating immune inflammatory cells such as platelets, neutrophils and lymphocytes play an important role in promoting the proliferation, invasion and migration of cancer cells by changing the tumor microenvironment. 10 Recently, several inflammation-based scores, mainly including SII, NLR and PLR, have been served as useful prognostic biomarkers for multiple solid tumors.…”

Systemic Immune-Inflammation Index Is a Prognostic Predictor in Patients with Intrahepatic Cholangiocarcinoma Undergoing Liver Transplantation

“…As mentioned earlier, some studies have shown that inflammation factors are associated with prognosis in patients with cancer [ 16 – 18 ]. SII is widely accepted to be a new predictive marker to predict the prognosis of several types of cancer [ 19 – 21 ].…”

Serum levels of inflammatory markers CRP, ESR and albumin in relation to survival for patients with hepatocellular carcinoma

“…Inflammation, both local (CRP) and systemic (ESR) has recently emerged as an important reflection of HCC aggressiveness and prognosticator. Various other clinical approaches have been taken to its measurement, including peripheral blood neutrophil to lymphocyte (NLR) and platelet to lymphocyte (PLR) ratios 21,33‐49 . These novel markers of disease activity are especially needed for that 50% of HCC patients who do not have elevated AFP levels 30,46,50 .…”

“…Various other clinical approaches have been taken to its measurement, including peripheral blood neutrophil to lymphocyte (NLR) and platelet to lymphocyte (PLR) ratios. 21,[33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] These novel markers of disease activity are especially needed for that 50% of HCC patients who do not have elevated AFP levels. 30,46,50 However, a central unanswered question is why elevated values of these inflammation markers predict poor survival.…”