Inflammation scores predict survival for hepatitis B virus-related hepatocellular carcinoma patients after transarterial chemoembolization

doi:10.3748/wjg.v21.i18.5582

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastroenterol. May 14, 2015; 21(18): 5582-5590
Published online May 14, 2015. doi: 10.3748/wjg.v21.i18.5582

Table 1 Inflammation-based prognostic scores

Scoring systems	Score
Glasgow Prognostic Score
CRP ( ≤ 10 mg/L) and albumin (≥ 35 g/L)	0
CRP ( ≤ 10 mg/L) and albumin (< 35 g/L)	1
CRP (> 10 mg/L) and albumin (≥ 35 g/L)	1
CRP (> 10 mg/L) and albumin (< 35 g/L)	2
Modified Glasgow Prognostic Score
CRP ( ≤ 10 mg/L) and albumin (≥ 35 g/L)	0
CRP ( ≤ 10 mg/L) and albumin (< 35 g/L)	0
CRP (> 10 mg/L)	1
CRP (> 10 mg/L) and albumin (< 35 g/L)	2
Neutrophil-lymphocyte ratio
Neutrophil count:lymphocyte count < 3:1	0
Neutrophil count:lymphocyte count ≥ 3:1	1
Plt-lymphocyte ratio
Plt count:lymphocyte count < 150:1	0
Plt count:lymphocyte count ≥ 150:1	1
Plt count:lymphocyte count > 300:1	2
Prognostic index
CRP ( ≤ 10 mg/L) and WBC ( ≤ 11 × 10⁹/L)	0
CRP ( ≤ 10 mg/L) and WBC (> 11 × 10⁹/L)	1
CRP (> 10 mg/L) and WBC ( ≤ 11 × 10⁹/L)	1
CRP (> 10 mg/L) and WBC (> 11 × 10⁹/L)	2
Prognostic Nutritional Index
Albumin (g/L) × total lymphocyte count × 10⁹/L ≥ 45	0
Albumin (g/L) × total lymphocyte count × 10⁹/L < 45	1

CRP: C-reactive protein; Plt: Platelet; WBC: White blood cell count.

Table 2 Baseline characteristics for hepatocellular carcinoma patients undergoing transarterial chemoembolization (n = 224)

Variables	Value
Age (yr)	53 (23-80)
Sex (M/F)	199/25
WBC (× 10⁹/L)	6.6 (2.1-24.6)
Neutrophil count (× 10⁹/L)	4.2 (0.7-13.6)
Lymphocyte count (× 10⁹/L)	1.5 (0.3-4.8)
CRP (mg/L)	21.1 (0.2-218.3)
PLT count (× 10⁹/L)	182 (23-548)
ALT (U/L)	55.6 (8.0-304.0)
AST (U/L)	76.3 (20.2-472.6)
Albumin (g/L)	38.9 (7.6-79.4)
Total serum bilirubin (mmol/L)	18.0 (4.8-222.9)
ALP (IU/L)	148.7 (13.0-574.6)
AFP (ng/mL)	25828.4 (1.3-1210000.0)
AFU (U/L)	43.8 (12.6-992.0)
Diameter of largest lesion (cm)	9.2 (1.4-20.0)
Tumor number (solitary/multiple)	71/153
Vascular invasion (absent/present)	149/75
Child-Pugh grade (A/B)	208/16
GPS (0/1/2)	99/101/24
Modified GPS (0/1/2)	115/85/24
NLR (0/1)	108/116
PLR (0/1/2)	156/57/11
PI (0/1/2)	115/102/7
PNI (0/1)	154/70
TNM stage (I/II/IIIa/IIIb/IVa/IVb)	44/24/71/52/5/28
CLIP score (0/1/2/3/4/5)	19/56/70/43/34/2
BCLC stage (A/B/C)	10/124/90

AFP: Alpha-fetoprotein level; ALT: Alanine aminotransferase; ALP: Alkaline phosphatase; AFU: Alpha-L-fucosidase; AST: Aspartate aminotransferase; BCLC: Barcelona Clinic Liver Cancer; CLIP: Cancer of the Liver Italian Program; CRP: C-reactive protein; GPS: Glasgow Prognostic Score; NLR: Neutrophil-lymphocyte ratio; PI: Prognostic Index; PLR: Platelet-lymphocyte ratio; PNI: Prognostic Nutritional Index; TNM: Tumor-node-metastasis; WBC: White blood cell count. Data are presented as mean (range) or n.

Table 3 Univariate and multivariate analyses of overall survival for hepatocellular carcinoma patients undergoing transarterial chemoembolization (n = 224)

Variable	Univariate analysis	Multivariate analysis
Variable	P value	HR (95%CI)	P value
Age (< 60/≥ 60 yr)	0.008
Sex (M/F)	0.118
WBC ( ≤ 10/> 10 × 10⁹/L)	0.094
Neutrophil count ( ≤ 7/> 7 × 10⁹/L)	0.038
Lymphocyte count ( ≤ 0.8/> 0.8 × 10⁹/L)	0.088
CRP ( ≤ 8/> 8 mg/L)	< 0.001
PLT count ( ≤ 100/> 100 × 10⁹/L)	0.472
ALT ( ≤ 40/> 40 U/L)	0.002	1.005 (1.001-1.009)	0.008
AST ( ≤ 45/> 45 U/L)	< 0.001
Albumin ( ≤ 35/> 35 g/L)	0.208
Total bilirubin ( ≤ 20.5/> 20.5 mmol/L)	< 0.001
ALP ( ≤ 110/> 110 IU/L)	< 0.001
AFP ( ≤ 400/> 400 ng/ml)	< 0.001
AFU ( ≤ 40/> 40 U/L)	0.042
Diameter of largest lesion (< 8/≥ 8 cm)	< 0.001
Tumor number (solitary/multiple)	0.025
Vascular invasion (absent/present)	< 0.001
Child-Pugh grade (A/B)	0.030
GPS (0/1/2)	< 0.001	1.697 (1.325-2.174)	< 0.001
Modified GPS (0/1/2)	< 0.001
NLR (0/1)	0.009
PLR (0/1/2)	0.553
PI (0/1/2)	< 0.001
PNI (0/1)	0.573
TNM stage (I/II/IIIa/IIIb/IVa/IVb)	< 0.001
CLIP score (0/1/2/3/4/5)	< 0.001	1.297 (1.1-1.53)	0.002
BCLC stage (A/B/C)	< 0.001

AFP: Alpha-fetoprotein level; ALT: Alanine aminotransferase; ALP: Alkaline phosphatase; AFU: Alpha-L-fucosidase; AST: Aspartate aminotransferase; BCLC: Barcelona Clinic Liver Cancer; CI: Confidence interval; CLIP: Cancer of the Liver Italian Program; CRP: C-reactive protein; GPS: Glasgow Prognostic Score; HR: Hazard ratio; NLR: Neutrophil-lymphocyte ratio; PI: Prognostic Index; PLR: Platelet-lymphocyte ratio; PLT: Platelet; PNI: Prognostic Nutritional Index; TNM: Tumor-node-metastasis; WBC: White blood cell count.

Table 4 Comparison of the area under the curve between inflammation-based prognostic scores and staging systems

Period	AUC	95%CI	P value
6-mo
GPS	0.702	0.630-0.773	< 0.001
mGPS	0.699	0.627-0.770	< 0.001
PI	0.681	0.609-0.754	< 0.001
NLR	0.582	0.505-0.659	0.410
PNI	0.561	0.482-0.640	0.126
PLR	0.531	0.385-0.629	0.436
TNM	0.649	0.575-0.723	< 0.001
BCLC	0.635	0.559-0.712	0.001
CLIP	0.656	0.582-0.730	< 0.001
12-mo
GPS	0.676	0.604-0.747	< 0.001
mGPS	0.665	0.592-0.738	< 0.001
PI	0.652	0.577-0.726	< 0.001
NLR	0.590	0.513-0.667	0.024
PNI	0.527	0.450-0.605	0.495
PLR	0.537	0.460-0.615	0.346
TNM	0.651	0.576-0.725	< 0.001
BCLC	0.656	0.584-0.729	< 0.001
CLIP	0.711	0.644-0.778	< 0.001
24-mo
GPS	0.687	0.601-0.772	< 0.001
mGPS	0.684	0.601-0.767	< 0.001
PI	0.682	0.599-0.766	< 0.001
NLR	0.593	0.498-0.688	0.063
PNI	0.512	0.415-0.609	0.808
PLR	0.554	0.457-0.652	0.279
TNM	0.706	0.621-0.791	< 0.001
BCLC	0.656	0.572-0.741	0.002
CLIP	0.721	0.644-0.797	< 0.001

BCLC: Barcelona Clinic Liver Cancer; CI: Confidence interval; CLIP: Cancer of the Liver Italian Program; GPS: Glasgow Prognostic Score; mGPS: Modifed Glasgow Prognostic Score; NLR: Neutrophil lymphocyte ratio; PI: Prognostic index; PLR: Platelet-lymphocyte ratio; PNI: Prognostic nutritional index; TNM: Tumor-node-metastasis.

Table 5 Combined score of the Glasgow Prognostic Score and Cancer of the Liver Italian Program score

Variables	Score
Variables	0	1	2
Child-Pugh stage	A	B	C
Tumor morphology	Uninodular and extension ≤ 50%	multinodular and extension ≤ 50%	multinodular or extension > 50%
AFP (ng/mL)	< 400	≥ 400
Portal vein thrombosis	No	Yes
GPS	CRP ≤ 10 mg/L and albumin ≥ 35 g/L	(CRP ≤ 10 mg/L and albumin < 35 g/L) or (CRP > 10 mg/L and albumin ≥ 35 g/L)	CRP > 10 mg/L and albumin < 35 g/L

AFP: Alpha-fetoprotein level; CRP: C-reactive protein.

Citation: Zhou DS, Xu L, Luo YL, He FY, Huang JT, Zhang YJ, Chen MS. Inflammation scores predict survival for hepatitis B virus-related hepatocellular carcinoma patients after transarterial chemoembolization. World J Gastroenterol 2015; 21(18): 5582-5590
URL: https://www.wjgnet.com/1007-9327/full/v21/i18/5582.htm
DOI: https://dx.doi.org/10.3748/wjg.v21.i18.5582