Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2015; 21(18): 5582-5590
Published online May 14, 2015. doi: 10.3748/wjg.v21.i18.5582
Inflammation scores predict survival for hepatitis B virus-related hepatocellular carcinoma patients after transarterial chemoembolization
Dong-Sheng Zhou, Li Xu, Yao-Ling Luo, Feng-Ying He, Jun-Ting Huang, Yao-Jun Zhang, Min-Shan Chen
Dong-Sheng Zhou, Li Xu, Feng-Ying He, Jun-Ting Huang, Yao-Jun Zhang, Min-Shan Chen, Department of Hepatobiliary Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
Dong-Sheng Zhou, Li Xu, Yao-Ling Luo, Feng-Ying He, Jun-Ting Huang, Yao-Jun Zhang, Min-Shan Chen, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong Province, China
Yao-Ling Luo, Department of Clinical Laboratory, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
Author contributions: Zhou DS and Xu L contributed equally to this work; Zhou DS, Xu L, Luo YL, He FY, Huang JT, Zhang YJ and Chen MS designed research; Zhou DS, Luo YL and He FY performed research; Xu L and Huang JT contributed new reagents/analytic tools; Zhou DS, Xu L and Zhang YJ analyzed data; and Zhou DS, Xu L, Luo YL, He FY, Huang JT, Zhang YJ and Chen MS wrote the paper.
Supported by Project grants from the Health Medical Collaborative Innovation Program of Guangzhou, No. 201400000001-3.
Ethics approval: This study was reviewed and approved by the Sun Yat-Sen University Cancer Center Institutional Review Board.
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: The authors have no conflicts of interest to declare.
Data sharing: Not additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Min-Shan Chen, MD, PhD, Department of Hepatobiliary Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, Guangdong Province, China. chminsh@mail.sysu.edu.cn
Telephone: +86-20-87343117 Fax: +86-20-87343117
Received: October 4, 2014
Peer-review started: October 6, 2014
First decision: October 29, 2014
Revised: November 16, 2014
Accepted: January 21, 2015
Article in press: January 21, 2015
Published online: May 14, 2015
Processing time: 225 Days and 23 Hours
Abstract

AIM: To compare the prognostic ability of inflammation scores for patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE).

METHODS: Data of 224 consecutive patients who underwent TACE for unresectable HBV-related HCC from September 2009 to November 2011 were retrieved from a prospective database. The association of inflammation scores with clinicopathologic variables and overall survival (OS) were analyzed, and receiver operating characteristic curves were generated, and the area under the curve (AUC) was calculated to evaluate the discriminatory ability of each inflammation score and staging system, including tumor-node-metastasis, Barcelona Clinic Liver Cancer, and Cancer of the Liver Italian Program (CLIP) scores.

RESULTS: The median follow-up period was 390 d, the one-, two-, and three-year OS were 38.4%, 18.3%, and 11.1%, respectively, and the median OS was 390 d. The Glasgow Prognostic Score (GPS), modifed GPS, neutrophil-lymphocyte ratio, and Prognostic Index were associated with OS. The GPS consistently had a higher AUC value at 6 mo (0.702), 12 mo (0.676), and 24 mo (0.687) in comparison with other inflammation scores. CLIP consistently had a higher AUC value at 6 mo (0.656), 12 mo (0.711), and 24 mo (0.721) in comparison with tumor-node-metastasis and Barcelona Clinic Liver Cancer staging systems. Multivariate analysis revealed that alanine aminotransferase, GPS, and CLIP were independent prognostic factors for OS. The combination of GPS and CLIP (AUC = 0.777) was superior to CLIP or GPS alone in prognostic ability for OS.

CONCLUSION: The prognostic ability of GPS is superior to other inflammation scores for HCC patients undergoing TACE. Combining GPS and CLIP improved the prognostic power for OS.

Keywords: Hepatocellular carcinoma; Inflammation-based prognostic score; Prognostic index; Staging system; Transarterial chemoembolization

Core tip: This study compared the inflammation scores [including the Glasgow Prognostic Score (GPS), modified GPS, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, Prognostic Index, and Prognostic Nutritional Index] in patients with hepatitis B virus-related hepatocellular carcinoma undergoing transarterial chemoembolization, and concluded that GPS was superior to others. To improve the prognostic power, we proposed a new combined score containing GPS and Cancer of the Liver Italian Program, and the results showed that the combined scores enhanced the predictive ability. Thus, our study provides evidence for individualized treatment in clinical practice.