Background
Methods
Study population
Treatment and follow-up
Statistical analysis
Results
Patient and tumor characteristics
Variables |
n
| DFS |
P
| OS |
P
| ||||
---|---|---|---|---|---|---|---|---|---|
1-yr | 3-yrs | 5-yrs | 1-yr | 3-yrs | 5-yrs | ||||
Gender | |||||||||
Male | 285 | 43.5 % | 29.8 % | 25.8 % | 0.096 | 69.5 % | 44.6 % | 37.1 % | 0.026 |
Female | 36 | 55.6 % | 38.9 % | 38.9 % | 83.3 % | 61.1 % | 55.6 % | ||
Age(yrs) | |||||||||
< 60 | 244 | 43.9 % | 32.4 % | 29.5 % | 0.565 | 70.1 % | 47.1 % | 39.7 % | 0.677 |
≥ 60 | 77 | 48.1 % | 26.0 % | 20.3 % | 74.0 % | 44.2 % | 37.6 % | ||
HBsAg | |||||||||
Positive | 281 | 42.0 % | 29.5 % | 25.4 % | 0.049 | 69.4 % | 44.8 % | 38.0 % | 0.123 |
Negative | 40 | 65.0 % | 40.0 % | 40.0 % | 82.5 % | 57.5 % | 47.5 % | ||
AFP(μg/L) | |||||||||
< 200 | 139 | 54.0 % | 36.7 % | 34.5 % | 0.002 | 77.7 % | 51.8 % | 45.3 % | 0.015 |
≥ 200 | 182 | 37.9 % | 26.4 % | 21.8 % | 65.9 % | 42.3 % | 34.5 % | ||
ALT(U/L) | |||||||||
< 80 | 265 | 47.5 % | 32.4 % | 28.5 % | 0.108 | 73.2 % | 49.8 % | 41.8 % | 0.019 |
≥ 80 | 56 | 32.1 % | 23.2 % | 21.4 % | 60.7 % | 30.4 % | 26.8 % | ||
Hb(g/L) | |||||||||
≤ 120 | 57 | 33.3 % | 19.3 % | 17.5 % | 0.068 | 70.2 % | 35.1 % | 29.8 % | 0.215 |
> 120 | 264 | 47.3 % | 33.3 % | 29.4 % | 71.2 % | 48.9 % | 41.2 % | ||
WBC(×109) | |||||||||
< 10 | 287 | 46.0 % | 31.7 % | 27.8 % | 0.384 | 72.1 % | 46.3 % | 39.6 % | 0.795 |
≥ 10 | 34 | 35.3 % | 23.5 % | 23.5 % | 61.8 % | 47.1 % | 35.3 % | ||
Lymphocyte(×109) | |||||||||
< 4 | 313 | 44.7 % | 30.7 % | 27.0 % | 0.475 | 71.2 % | 46.3 % | 39.2 % | 0.988 |
≥ 4 | 8 | 50.0 % | 37.5 % | 37.5 % | 62.5 % | 50.0 % | 37.5 % | ||
TNM | |||||||||
I | 184 | 60.9 % | 42.9 % | 39.1 % | <0.001 | 84.8 % | 61.4 % | 55.4 % | <0.001 |
II-III | 137 | 23.4 % | 14.6 % | 11.3 % | 52.6 % | 26.3 % | 17.4 % | ||
Cirrhosis | |||||||||
No | 68 | 41.2 % | 27.9 % | 25.0 % | 0.541 | 76.5 % | 47.1 % | 38.2 % | 0.745 |
Yes | 253 | 45.8 % | 31.6 % | 27.9 % | 69.6 % | 46.2 % | 39.5 % | ||
PVTT | |||||||||
No | 263 | 52.5 % | 35.7 % | 31.8 % | <0.001 | 79.5 % | 52.9 % | 45.6 % | <0.001 |
Yes | 58 | 10.3 % | 8.6 % | 6.9 % | 32.8 % | 17.2 % | 10.1 % | ||
Tumor number | |||||||||
single | 226 | 54.0 % | 38.5 % | 34.0 % | <0.001 | 77.0 % | 54.9 % | 48.6 % | <0.001 |
multiple | 95 | 23.2 % | 12.5 % | 11.0 % | 56.8 % | 26.3 % | 16.7 % | ||
Tumor size(cm) | |||||||||
< 5 | 111 | 69.4 % | 51.4 % | 43.9 % | <0.001 | 88.4 % | 68.7 % | 60.7 % | <0.001 |
≥ 5 | 210 | 31.9 % | 20.0 % | 18.5 % | 61.4 % | 34.3 % | 27.5 % | ||
Complication | |||||||||
No | 273 | 44.7 % | 32.6 % | 28.4 % | 0.356 | 72.2 % | 46.9 % | 40.6 % | 0.345 |
Yes | 48 | 45.8 % | 20.8 % | 20.8 % | 64.6 % | 43.8 % | 31.0 % | ||
Tumor differentiation | |||||||||
I-II | 248 | 49.2 % | 34.3 % | 30.5 % | 0.001 | 73.4 % | 49.6 % | 43.5 % | 0.003 |
III-IV | 73 | 30.1 % | 19.2 % | 16.4 % | 63.0 % | 35.6 % | 24.5 % | ||
Resection margin(cm) | |||||||||
< 2 | 184 | 42.1 % | 26.8 % | 23.4 % | 0.138 | 69.9 % | 41.5 % | 34.3 % | 0.041 |
≥ 2 | 137 | 48.2 % | 35.7 % | 32.0 % | 72.3 % | 52.6 % | 45.2 % | ||
Intraoperative blood loss(ml) | |||||||||
≤ 1000 | 247 | 77.3 % | 51.8 % | 44.9 % | <0.001 | 50.2 % | 35.2 % | 31.4 % | <0.001 |
> 1000 | 74 | 50.0 % | 28.4 % | 20.1 % | 27.0 % | 16.2 % | 13.5 % | ||
NLR | |||||||||
≤ 2 | 153 | 53.6 % | 39.2 % | 34.6 % | <0.001 | 79.7 % | 58.8 % | 49.6 % | <0.001 |
> 2 | 168 | 36.9 % | 23.2 % | 20.6 % | 63.1 % | 35.1 % | 29.7 % | ||
PLR | |||||||||
≤ 115 | 182 | 51.1 % | 36.3 % | 31.2 % | 0.01 | 75.8 % | 54.9 % | 46.7 % | 0.002 |
> 115 | 139 | 36.7 % | 23.7 % | 22.2 % | 64.7 % | 35.3 % | 29.4 % | ||
APRI | |||||||||
≤ 1.68 | 108 | 57.4 % | 40.7 % | 37.8 % | <0.001 | 83.3 % | 59.3 % | 51.8 % | <0.001 |
> 1.68 | 213 | 38.5 % | 25.8 % | 21.9 % | 64.8 % | 39.9 % | 32.8 % | ||
PNI | |||||||||
≤ 45 | 68 | 33.8 % | 16.0 % | 11.9 % | 0.002 | 66.2 % | 36.8 % | 26.3 % | 0.006 |
> 45 | 253 | 47.8 % | 34.8 % | 31.2 % | 72.3 % | 49.0 % | 42.6 % |
Determination of cut-off value
Independent prognostic factors for HCC
Variables | DFS | OS | ||||
---|---|---|---|---|---|---|
HR | 95%CI |
P
| HR | 95%CI |
P
| |
PLR | 1.407 | 1.039-1.907 | 0.027 | |||
AFP | 1.317 | 1.006-1.724 | 0.045 | |||
TNM | 1.981 | 1.469-2.672 | <0.001 | 2.326 | 1.680-3.220 | <0.001 |
PVTT | 1.771 | 1.229-2.553 | 0.002 | 1.732 | 1.185-2.531 | 0.005 |
NLR | 1.405 | 1.076-1.833 | 0.012 | 1.473 | 1.083-2.004 | 0.014 |
APRI | 1.449 | 1.083-1.939 | 0.012 | 1.612 | 1.165-2.230 | 0.004 |
Correlation between preoperative NLR or APRI and 17 clinico-pathologic characteristics in HCC
Variables | Cases | NLR |
P value | APRI |
P value | ||
---|---|---|---|---|---|---|---|
≤2 | >2 | ≤1.68 | >1.68 | ||||
Age(yrs) | |||||||
≥ 60 | 77 | 32(41.6 %) | 45(58.4 %) | 0.219 | 24(31.2 %) | 53(68.8 %) | 0.598 |
< 60 | 244 | 121(49.6 %) | 123(50.4 %) | 84(34.4 %) | 160(65.6 %) | ||
Gender | |||||||
Male | 285 | 135(47.4 %) | 150(52.6 %) | 0.766 | 92(32.3 %) | 193(67.7 %) | 0.146 |
Female | 36 | 18(50.0 %) | 18(50.0 %) | 16(44.4 %) | 20(55.6 %) | ||
HCC family history | |||||||
Yes | 24 | 8(33.3 %) | 16(66.7 %) | 0.144 | 8(33.3 %) | 16(66.7 %) | 0.973 |
No | 297 | 145(48.8 %) | 152(51.2 %) | 100(33.7 %) | 197(66.3 %) | ||
HBsAg | |||||||
Positive | 281 | 134(47.7 %) | 147(52.3 %) | 0.982 | 86(30.6 %) | 195(69.4 %) | 0.002 |
Negative | 40 | 19(47.5 %) | 21(52.5 %) | 22(55.0 %) | 18(45.0 %) | ||
ALT(U/L) | |||||||
< 80 | 265 | 126(47.5 %) | 139(52.5 %) | 0.928 | 104(39.2 %) | 161(60.8 %) | <0.001 |
≥ 80 | 56 | 27(48.2 %) | 29(51.8 %) | 4(7.1 %) | 52(92.9 %) | ||
TBIL(μmol/L) | |||||||
< 34.2 | 294 | 144(49.0 %) | 150(51.0 %) | 0.119 | 106(36.1 %) | 188(63.9 %) | 0.003 |
≥ 34.2 | 27 | 9(33.3 %) | 18(66.7 %) | 2(7.4 %) | 25(92.6 %) | ||
PLT(×109) | |||||||
≥ 100 | 292 | 136(46.6 %) | 156(53.4 %) | 0.215 | 108(37.0 %) | 184(63.0 %) | <0.001 |
< 100 | 29 | 17(58.6 %) | 12(41.4 %) | 0(0.0 %) | 29(100.0 %) | ||
Cirrhosis | |||||||
Yes | 253 | 126(49.8 %) | 127(50.2 %) | 0.139 | 74(29.2 %) | 179(70.8 %) | 0.001 |
No | 68 | 27(39.7 %) | 41(60.3 %) | 34(50.0 %) | 34(50.0 %) | ||
AFP(μg/L) | |||||||
≥ 200 | 182 | 76(41.8 %) | 106(58.2 %) | 0.015 | 57(31.3 %) | 125(68.7 %) | 0.313 |
< 200 | 139 | 77(55.4 %) | 62(44.6 %) | 51(36.7 %) | 88(63.3 %) | ||
Tumor size(cm) | |||||||
> 5 | 210 | 76(36.2 %) | 134(63.8 %) | <0.001 | 65(31.0 %) | 145(69.0 %) | 0.160 |
≤ 5 | 111 | 77(69.4 %) | 34(30.6 %) | 43(38.7 %) | 68(61.3 %) | ||
Tumor number | |||||||
Single | 226 | 112(49.6 %) | 114(50.4 %) | 0.295 | 80(35.4 %) | 146(64.6 %) | 0.305 |
Multiple | 95 | 41(43.2 %) | 54(56.8 %) | 28(29.5 %) | 67(70.5 %) | ||
TNM | |||||||
I | 184 | 96(52.2 %) | 88(47.8 %) | 0.061 | 70(38.0 %) | 114(62.0 %) | 0.053 |
II-III | 137 | 57(41.6 %) | 80(58.4 %) | 38(27.7 %) | 99(72.3 %) | ||
Differentiation | |||||||
I-II | 248 | 119(48.0 %) | 129(52.0 %) | 0.832 | 85(34.3 %) | 163(65.7 %) | 0.660 |
III-IV | 73 | 34(46.6 %) | 39(53.4 %) | 23(31.5 %) | 50(68.5 %) | ||
PVTT | |||||||
Yes | 58 | 20(34.5 %) | 38(65.5 %) | 0.026 | 7(12.1 %) | 51(87.9 %) | <0.001 |
No | 263 | 133(50.6 %) | 130(49.4 %) | 101(38.4 %) | 162(61.6 %) | ||
Recurrence | |||||||
Yes | 235 | 101(43.0 %) | 134(57.0 %) | 0.005 | 67(28.5 %) | 168(71.5 %) | 0.001 |
No | 86 | 52(60.5 %) | 34(39.5 %) | 41(47.7 %) | 45(52.3 %) | ||
PNI | |||||||
≤ 45 | 68 | 15(22.1 %) | 53(77.9 %) | <0.001 | 10(14.7 %) | 58(85.3 %) | <0.001 |
> 45 | 253 | 138(54.5 %) | 115(45.5 %) | 98(38.7 %) | 155(61.3 %) | ||
PLR | |||||||
≤ 115 | 182 | 118(64.8 %) | 64(35.2 %) | <0.001 | 55(30.2 %) | 127(69.8 %) | 0.137 |
> 115 | 139 | 35(25.2 %) | 104(74.8 %) | 53(38.1 %) | 86(61.9 %) | ||
Complication | |||||||
No | 273 | 130(47.6 %) | 143(52.4 %) | 0.970 | 92(33.7 %) | 181(66.3 %) | 0.960 |
Yes | 48 | 23(47.9 %) | 25 (52.1 %) | 16(33.3 %) | 32(66.7 %) |
Overall and disease free survival rates according to NLR or APRI
The prognostic value of NLR combined with APRI for HCC after hepatectomy
Variable | Score |
---|---|
NLR | |
≤ 2 | 0 |
> 2 | 1 |
APRI | |
≤ 1.68 | 0 |
> 1.68 | 1 |
Prognostic stratification | |
0 | Low risk of mortality |
1 | Intermediate risk of mortality |
2 | High risk of mortality |