HBV-DNA Load-Related Peritumoral Inflammation and ALBI Scores Predict HBV Associated Hepatocellular Carcinoma Prognosis after Curative Resection

Abstract

Background: Both persistent inflammatory activity and liver function damage contribute to a poor prognosis of hepatocellular carcinoma (HCC). This study aimed to develop nomograms that incorporate hepatitis virus B (HBV)-related peritumoral inflammation score (PIS) and liver function based on ALBI score to predict postoperative outcomes of HCC.

Methods: The prognostic roles of HBV-related preoperative PIS and ALBI scores in HCC recurrence were examined, and then two nomograms were constructed. The predictive accuracy and discriminative ability of the nomograms were compared with AJCC and BCLC staging systems of HCC.

Results: PIS (HBV-PIS) and ALBI scores (HBV-ALBI) with different HBV-DNA loads had association with overall survival (OS) and/or recurrence-free survival (RFS) of HCC. The independent predictors of OS and RFS were incorporated into the corresponding nomograms. In the training cohort, the C-indexes of OS and RFS nomograms were 0.751 and 0.736, respectively. ROC analyses showed that both OS and RFS nomograms had larger AUC (0.775 and 0.739, respectively) than AJCC and BCLC staging systems. These results were verified by the internal and external validation cohorts.

Conclusion: The proposed nomograms, including HBV-DNA load-related PIS and ALBI scores, were accurate in predicting survival for HCC after curative resection.

Figure 1

Four levels of inflammatory infiltrate according to Ishak score (a-d). HBV-DNA load related peritumoral inflammatory score (HBV-PIS) and ALBI score (HBV-ALBI) are associated with overall survival (OS) and recurrence-free survival (RFS) of patients with hepatocellular carcinoma (HCC) in training cohort, respectively (e-h).

Figure 2

Nomograms for predicting survival of hepatocellular carcinoma patients after hepatectomy. To calculate the probability of overall survival (OS, (a)) and recurrence-free survival (RFS, (b)), straight upward lines are drawn to determine the points accrued. The sum of these points is plotted on the total points bar to the probability to yield the 1-, 3-, and 5-year survival or recurrence rates.

Figure 3

Predictive accuracy comparison of each variable included in the nomograms ((a) and (b)) and comparison between the nomograms and two conventional clinical staging systems (AJCC and BCLC staging systems, (c) and (d)) by ROC curve analyses for overall survival (OS, (a) and (c)) and recurrence-free survival (RFS, (b) and (d)) in the training cohort, respectively. The numbers shown in right lower part of each panel (a-d) represent the area under receiver operating characteristics curves of the parameters.

Figure 4

The calibration curves for predicting 1- ((a) and (b)), 3- ((c), and (d)) and 5-year ((e) and (f)) overall survival (OS, (a), (c) and (e)) and recurrence-free survival (RFS, (b), (d), and (f)) rates by nomograms prediction and actual observation in patients with hepatocellular carcinoma in the training cohort, respectively.