The Role of Easy-to-use Non-invasive Scores in the Assessment of Hepatocellular Carcinoma Prognosis - Data from the Romanian Hepatocellular Carcinoma Registry

Abstract

Background and aims: Hepatocellular carcinoma (HCC) is currently the third leading cause of cancer-related mortality, a figure that is on the rise. The shared hallmark of different etiologies, progression, and HCC survival is chronic inflammation, making it a significant field of interest for prognostic and therapeutic strategies. We aimed to evaluate the prognostic accuracy of several inflammation-based scores in HCC.

Methods: A consecutive series of patients at their first HCC diagnosis were enrolled during a 5-year timespan in a prospectively maintained multicentric database. Demographic, clinical, biological, and imagistic data were collected. Representative inflammation-based prognostic scores, including the platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), systemic immune inflammation index (SII), prognostic nutritional index (PNI), albumin-to-bilirubin index (ALBI), platelet-albumin-bilirubin-index (PALBI), AST-to-lymphocyte ratio (ALRI), AST/ALT, AST-to-platelet ratio (APRI) were assessed for prediction of overall survival (OS) in a scenario-based setting, using Kaplan-Meier curves, univariate and multivariate analyses.

Results: A total of 467 patients from five tertiary-care hospitals were enrolled in this study. The median age was 64.94 years, and the most frequent etiology of the liver disease was hepatitis C (50%). During a median of 14.85 (35) months of follow-up, the cumulative mortality was 84.8%. In the univariate analysis, PNI (HR=2.414; p=0.021), ALBI grade (HR=2.023; p<0.001), and PALBI grade (HR=2.022; p<0.001) demonstrated the highest prognostic accuracies for OS in HCC, regardless of the clinical scenario. Moreover, PLR (HR=1.635; p=0.002), ALRI (HR=1.555; p<0.001), NLR (HR=1.461; p=0.007), AST/ALT (HR=1.420; p=0.012), and APRI (HR=1.356; p=0.009) were also significant prognostic factors for OS. The multivariate analysis showed that only ALBI grade (HR=1.974; p<0.001), SII (HR=1.487; p=0.009), and PLR (HR=1.647; p=0.014) were independently associated with OS.

Conclusions: Inflammation-based scores allow for an accurate prediction of survival in HCC. Their ability to predict the response to treatment and complications merits further investigation.