Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2024; 30(48): 5130-5151
Published online Dec 28, 2024. doi: 10.3748/wjg.v30.i48.5130
Prognostic value of preoperative systemic immune-inflammation index/albumin for patients with hepatocellular carcinoma undergoing curative resection
Kun-Lin Chen, Yi-Wen Qiu, Ming Yang, Tao Wang, Yi Yang, Hai-Zhou Qiu, Ting Sun, Wen-Tao Wang
Kun-Lin Chen, Yi-Wen Qiu, Ming Yang, Tao Wang, Yi Yang, Hai-Zhou Qiu, Ting Sun, Wen-Tao Wang, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Chen KL wrote the original draft of the manuscript; Chen KL, Qiu YW, and Yang M conceptualized the study; Chen KL, Qiu YW, Yang M, Wang T, Yang Y, Qiu HZ, Sun T, and Wang WT reviewed and edited the manuscript; all of the authors read and approved the final version of the manuscript to be published.
Supported by The National Natural Science Foundation of China, No. 81770566 and No. 82000599; The NHC Key Laboratory of Echinococcosis Prevention and Control, No. 2021WZK1004; and The Health Commission of the Tibet Autonomous Region, No. 311220432.
Institutional review board statement: The study was conducted in accordance with the principles of the 1964 Declaration of Helsinki and its later amendments, and this study was approved by the Institutional Review Board of West China Hospital of Sichuan University Ethics Committee, No. 2024(189).
Informed consent statement: Patient consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: All authors have no conflicts of interest to disclose.
Data sharing statement: The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen-Tao Wang, MD, PhD, Chief Doctor, Professor, Department of Liver Surgery, West China Hospital of Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu 610041, Sichuan Province, China. wwtdoctor02@163.com
Received: June 20, 2024
Revised: September 20, 2024
Accepted: October 8, 2024
Published online: December 28, 2024
Processing time: 161 Days and 22.4 Hours
Abstract
BACKGROUND

Hepatocellular carcinoma (HCC) is a major factor for cancer-associated mortality globally. Although the systemic immune-inflammation index (SII) and albumin (ALB) show individual prognostic value for various cancers, their combined significance (SII/ALB) in HCC patients undergoing curative hepatectomy is still unknown. It is hypothesized that a higher SII/ALB ratio correlates with poorer outcomes with regard to overall survival (OS) and recurrence-free survival (RFS).

AIM

To investigate the effect of preoperative SII/ALB in predicting the prognosis of HCC patients undergoing hepatectomy.

METHODS

Patients who received curative surgery for HCC at a single institution between 2014 and 2019 were retrospectively analyzed. Cox proportional hazards models and Kaplan-Meier curves were utilized to estimate OS and RFS. A nomogram was created using prognostic factors determined by the least absolute shrinkage and selection operator method and analyzed using multivariate Cox regression. This nomogram was assessed internally through the calibration plots, receiver operating characteristic (ROC) analysis, decision curve analysis (DCA) and the concordance index (C-index).

RESULTS

This study enrolled 1653 HCC patients. Multivariate analyses demonstrated that SII/ALB independently predicted OS [hazard ratio (HR) = 1.22, 95%CI: 1.03-1.46, P = 0.025] and RFS (HR = 1.19, 95%CI: 1.03-1.38, P = 0.022). Age, alpha-fetoprotein, hepatitis B surface antigen, albumin-bilirubin grade, tumor diameter, portal vein tumor thrombus, tumor number, and SII/ALB were incorporated into the nomogram to predict OS. The nomogram had a C-index of 0.73 (95%CI: 0.71-0.76) and 0.71 (95%CI: 0.67-0.74) for the training and validation cohorts, respectively. The area under the ROC curve, DCA and calibration curves demonstrated high accuracy and clinical benefits.

CONCLUSION

The SII/ALB may independently predict outcomes in HCC patients who receive curative surgical treatment. In addition, the nomogram can be used in HCC treatment decision-making.

Keywords: Hepatocellular carcinoma; Inflammation; Systemic immune-inflammation index/albumin; Liver resection; Prognosis

Core Tip: This study validates the systemic immune-inflammation index/albumin ratio (SII/ALB) as a novel prognostic marker for hepatocellular carcinoma (HCC) patients after hepatectomy. It was shown that SII/ALB independently predicted overall and recurrence-free survival. Incorporating SII/ALB into a predictive nomogram demonstrated superior accuracy and clinical utility, providing a refined tool for personalized treatment strategies in HCC management.