Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2021; 9(36): 11193-11207
Published online Dec 26, 2021. doi: 10.12998/wjcc.v9.i36.11193
Nomogram based on inflammation-related markers for predicting survival of patients undergoing hepatectomy for hepatocellular carcinoma
Tian Pu, Zi-Han Li, Dong Jiang, Jiang-Ming Chen, Qi Guo, Ming Cai, Zi-Xiang Chen, Kun Xie, Yi-Jun Zhao, Fu-Bao Liu
Tian Pu, Zi-Han Li, Dong Jiang, Jiang-Ming Chen, Qi Guo, Zi-Xiang Chen, Kun Xie, Yi-Jun Zhao, Fu-Bao Liu, Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
Ming Cai, Department of General Surgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei 230022, Anhui Province, China
Author contributions: Liu FB proposed the study; Chen ZX, Xie K and ZhaoYJ interpreted the results and prepared and revised the manuscript; Chen JM, Guo Q and Cai M extracted the clinical data and calculated the clinical correlations; Pu T, Li ZH and Jiang D contributed to the data analysis and manuscript writing; all authors contributed to the design and interpretation of the study and to further drafts and approved the final version to be published; Liu FB is the guarantor.
Supported by Key Research and Development Plan of Anhui Province, No. 1804h08020239 (Dr. Liu FB).
Institutional review board statement: The study was reviewed and approved by the First Affiliated Hospital of Anhui Medical University Institutional Review Board [(Approval No. Quick-PJ 2021-01-22)].
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare that there are no any conflicts of interest.
Data sharing statement: No additional data are available.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fu-Bao Liu, MD, PhD, Chief Doctor, Professor, Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei 230022, Anhui Province, China. lancetlfb@126.com
Received: May 3, 2021
Peer-review started: May 3, 2021
First decision: June 2, 2021
Revised: June 16, 2021
Accepted: August 24, 2021
Article in press: August 24, 2021
Published online: December 26, 2021
Processing time: 234 Days and 4.2 Hours
Abstract
BACKGROUND

Previous nomograms for hepatocellular carcinoma (HCC) did not include the neutrophil-to-lymphocyte ratio (NLR) or platelet-to-lymphocyte ratio (PLR). This study aimed to establish an effective nomogram capable of estimating the association between preoperative inflammatory factors and overall survival (OS) of HCC patients after hepatectomy.

AIM

To analyse the factors affecting the prognosis of HCC and establish a nomogram.

METHODS

A total of 626 HCC patients (410 training set patients from the First Affiliated Hospital of Anhui Medical University and 216 validation set patients from the First Affiliated Hospital of University of Science and Technology of China) underwent hepatectomy from January 2014 to December 2017 and were followed up every 3–6 mo. The nomogram was based on OS-related independent risk factors identified by Cox regression analysis. The C-index, calibration curve, and area under the curve (AUC) were used to evaluate the nomogram’s accuracy.

RESULTS

The 1-, 2- and 3-year OS rates were 79.0%, 68.0% and 45.4% in the training cohort (median OS = 34 mo) and 92.1%, 73.9% and 51.2% in the validation cohort (median OS = 38 mo). Higher α-fetoprotein [hazard ratio (HR) = 1.812, 95% confidence interval (CI): 1.343–2.444], NLR (HR = 2.480, 95%CI: 1.856–3.312) and PLR (HR = 1.974, 95%CI: 1.490–2.616), tumour size ≥ 5 cm (HR = 1.323, 95%CI: 1.002–1.747), and poor differentiation (HR = 3.207, 95%CI: 1.944–5.290) were significantly associated with shortened OS. The developed nomogram integrating these variables showed good reliability in both the training (C-index = 0.71) and validation cohorts (C-index = 0.75). For predicting 1-, 2- and 3-year OS, the nomogram had AUCs of 0.781, 0.743 and 0.706 in the training cohort and 0.789, 0.815 and 0.813 in the validation cohort. The nomogram was more accurate in predicting prognosis than the AJCC TNM staging system.

CONCLUSION

The prognostic nomogram combining pathological characteristics and inflammation indicators could provide a more accurate individualized risk estimate for the OS of HCC patients with hepatectomy.

Keywords: Liver malignancy; Nomogram; Overall survival; Neutrophil-to-lymphocyte ratio; Platelet-to-lymphocyte ratio

Core tip: Inflammation is a systemic process involving multicell participation, multipathway activation, and multifunctional execution. Prognosis of hepatocellular carcinoma (HCC) depends on progression of liver malignancy but is also affected by inflammation. Nomograms, as a visualization method of statistical models, gradually improve individualization with the inclusion of risk factors, providing clinicians and patients with information to effectively stratify liver malignancy patients and formulate personalized treatments. The nomograms developed in the past focused on pathological characteristics. In this study, we developed a nomogram that could predict the prognosis of HCC patients after hepatectomy based on tumour pathological characteristics and inflammation indicators.