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. 2022 Apr 5:15:2229-2241.
doi: 10.2147/JIR.S359498. eCollection 2022.

Combining Pre- and Postoperative Lymphocyte-C-Reactive Protein Ratios Can Better Predict Hepatocellular Carcinoma Prognosis After Partial Hepatectomy

Hang Hang Ni #  1   2 , Zhan Lu #  1   2 , Xi Huang  1 , Shang Wu Ning  1 , Xiao Ling Liang  1 , Shu Yi Zhang  1 , Bang De Xiang  1   2   3
Affiliations

Combining Pre- and Postoperative Lymphocyte-C-Reactive Protein Ratios Can Better Predict Hepatocellular Carcinoma Prognosis After Partial Hepatectomy

Hang Hang Ni et al. J Inflamm Res. .

Abstract

Background: Various preoperative inflammatory indicators have been identified as potential predictors of poor prognosis in patients with hepatocellular carcinoma (HCC), but the role of postoperative inflammatory indicators remains unclear. This study aimed to explore the prognostic value of the postoperative lymphocyte-C-reactive protein ratio (PostLCR) on its own and combined with preoperative LCR (PreLCR).

Methods: A total of 290 patients with primary HCC were retrospectively enrolled in the study. Univariate analysis was used to identify factors significantly associated with poor disease-free survival (DFS) and overall survival (OS), then multivariate analysis was performed to identify independent prognostic indicators of poor survival. Prognostic models based on preoperative, postoperative, and both types of indicators were then constructed, and their predictive performance were evaluated using time-dependent receiver operating characteristic curves and the concordance index (C-index).

Results: PreLCR and PostLCR levels correlated with DFS and OS more strongly than other pre- and postoperative inflammatory indicators, respectively. Decreased PreLCR and PostLCR were independent prognostic factors for both DFS and OS, while HCC patients with decreased PreLCR and PostLCR had worse prognosis than patients with increased PreLCR and PostLCR. Patients into three groups based on their cut-off values of PreLCR and PostLCR, Kaplan-Meier survival analysis indicated that HCC patients with low PreLCR and PostLCR had the worst DFS and OS. The combined model showed better predictive performance at 1 and 3 years post-surgery than individual pre- and postoperative models, the American Joint Committee on Cancer/Tumor-Node-Metastasis (8th edition) staging system and the Barcelona Clinic Liver Cancer system. The combine model demonstrated a markedly superior C-index compared with the other models in DFS and OS.

Conclusion: Our study showed PreLCR and PostLCR are independent predictors of DFS and OS in HCC patients after partial hepatectomy. Models that include both PreLCR and PostLCR can predict prognosis better than well-established clinical staging systems.

Keywords: disease-free survival; hepatocellular carcinoma; lymphocyte-to-C-reactive protein ratio; partial hepatectomy; postoperative.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Receiver operating characteristic curves of preoperative markers for disease-free survival in patients with hepatocellular carcinoma. The red font means the largest AUC among all 6 inflammation biomarkers.
Figure 2
Figure 2
Receiver operating characteristic curves of postoperative markers for disease-free survival in patients with hepatocellular carcinoma. The red font means the largest AUC among all 6 inflammation biomarkers.
Figure 3
Figure 3
Kaplan–Meier survival curves of disease-free survival in hepatocellular carcinoma patients based on (A) preoperative lymphocyte–C-reactive protein ratio (PreLCR) and (B) postoperative lymphocyte–C-reactive protein ratio (PostLCR).
Figure 4
Figure 4
Kaplan–Meier survival curves of disease-free survival (A) and overall survival (B) in hepatocellular carcinoma patients based on PreLCR and PostLCR.
Figure 5
Figure 5
Nomogram of the preoperative model for disease-free survival (DFS) in patients with hepatocellular carcinoma (A). Calibration curves of the preoperative model for (B) 1-year and (C) 3-year DFS.
Figure 6
Figure 6
Nomogram of the postoperative model for disease-free survival (DFS) in patients with hepatocellular carcinoma (A). Calibration curves of the postoperative model for (B) 1-year and (C) 3-year DFS.
Figure 7
Figure 7
Nomogram of the combined prognostic model for disease-free survival (DFS) in patients with hepatocellular carcinoma (A). Calibration curves of the combined prognostic model for (B) 1-year and (C) 3-year DFS.
Figure 8
Figure 8
Comparison of prognostic models and traditional clinical staging systems for predicting disease-free survival (DFS) at (A) 1 year and (B) 3 years after surgery.
See this image and copyright information in PMC

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