Background
Patients and methods
Patients
Diagnosis and definitions
Calculation of systemic inflammation-based prognostic models
Surgical procedure and follow-up
Statistical analysis
Results
Patient characteristics
Variables | Total (n = 1502) | Low FAR (n = 1126) | High FAR (n = 376) | P value |
---|---|---|---|---|
Age(years) | 50 (43, 59) | 50 (42, 59) | 52 (45, 60) | 0.017 |
Sex | 0.242 | |||
Male | 1291 (86.0) | 961 (85.3) | 330 (87.8) | |
Female | 211 (14.0) | 165 (14.7) | 46 (12.2) | |
Positive HBsAg | 1297 (86.4) | 979 (86.9) | 318(84.6) | 0.246 |
Positive anti-HCV | 22 (1.5) | 18 (1.6) | 4 (1.1) | 0.455 |
Platelet count (109/L) | 207 (160, 266) | 192 (149, 243) | 263 (211, 336) | < 0.001 |
Neutrophil count (109/L) | 3.6 (2.8, 4.8) | 3.3 (2.6, 4.4) | 4.5 (3.6, 5.9) | < 0.001 |
Lymphocyte count (109/L) | 1.7 (1.4, 2.2) | 1.8 (1.4, 2.2) | 1.7 (1.3, 2.1) | < 0.001 |
Monocyte count (109/L) | 0.5 (0.4, 0.6) | 0.4 (0.3, 0.6) | 0.6 (0.4, 0.8) | < 0.001 |
Total bilirubin (μmol/L) | 13.1 (9.7, 17.9) | 13.2 (9.9, 17.8) | 12.8 (9.4, 18.2) | 0.615 |
Albumin (g/L) | 39.4 (36.2, 42.4) | 40.3 (37.4, 43.3) | 35.9 (33.5, 39.2) | < 0.001 |
ALT (U/L) | 35 (24, 50) | 35 (24, 50) | 34 (22, 54) | 0.813 |
AST (U/L) | 39 (29, 57) | 37 (29, 54) | 46 (32, 69) | < 0.001 |
Prothrombin time (s) | 12.8 (12.0, 13.6) | 12.7 (12.0, 13.6) | 12.9 (12.2, 13.9) | 0.106 |
Fibrinogen (g/L) | 2.7 (2.2, 3.4) | 2.5 (2.1, 2.9) | 4.0 (3.5, 4.7) | < 0.001 |
Child–Pugh grade | < 0.001 | |||
A | 1401 (93.3) | 1076 (95.6) | 325 (86.4) | |
B | 101 (6.7) | 50 (4.4) | 51 (13.6) | |
AFP ( ng/mL) | 0.449 | |||
≥ 400 | 638 (42.5) | 472 (41.9) | 166 (44.1) | |
< 400 | 864 (57.5) | 654 (58.1) | 210 (55.9) | |
FAR | 6.9 (5.5, 8.9) | 6.2 (5.2, 7.3) | 10.9 (9.6, 13.1) | < 0.001 |
NLR | 2.1 (1.5, 3.0) | 1.9 (1.4, 2.5) | 2.9 (2.0, 4.1) | < 0.001 |
PLR | 115.7 (85.4, 160.6) | 104.6 (79.5, 141.7) | 157.0 (116.3, 210.5) | < 0.001 |
MLR | 0.3 (0.2, 0.4) | 0.2 (0.2, 0.3) | 0.3 (0.3, 0.5) | < 0.001 |
SII | 422 (262, 682) | 354 (229, 543) | 744 (485, 1156) | < 0.001 |
CSPH | 136 (9.1) | 111 (9.9) | 25 (6.6) | 0.060 |
Ascites | 169 (11.3) | 106 (9.4) | 63 (16.8) | < 0.001 |
Cirrhosis | 680 (45.3) | 527 (46.8) | 153 (40.7) | 0.039 |
Tumour size | < 0.001 | |||
> 5 | 883 (58.8) | 570 (50.6) | 313 (83.2) | |
≤ 5 | 619 (41.2) | 556 (49.4) | 63 (16.8) | |
Tumour number | 0.035 | |||
Multiple | 288 (19.2) | 202 (17.9) | 86 (29.9) | |
Single | 1214 (80.8) | 924 (82.1) | 290 (77.1) | |
MVI | 393 (26.2) | 241 (21.4) | 152 (38.7) | < 0.001 |
BCLC stage | < 0.001 | |||
0 | 53 (3.5) | 51 (4.5) | 2 (0.5) | |
A | 785 (52.3) | 633 (56.2) | 152 (40.4) | |
B | 257 (17.1) | 192 (17.1) | 65 (17.3) | |
C | 407 (27.1) | 250(22.2) | 157 (41.8) | |
Blood loss (mL) | < 0.001 | |||
≥ 400 | 541 (36.0) | 366 (32.5) | 175 (46.5) | |
< 400 | 961 (64.0) | 760 (67.5) | 201 (53.5) | |
Blood transfusion | 198 (13.2) | 123 (10.9) | 75 (19.9) | < 0.001 |
Extent of resection | < 0.001 | |||
Major hepatectomy | 754 (50.2) | 513 (45.6) | 241 (64.1) | |
Minor hepatectomy | 748 (49.8) | 613 (54.4) | 135 (35.9) |
Discriminatory performance of inflammation-based prognostic models
The optimal cut-off value of inflammation-based prognostic models
Correlation between FAR and clinicopathological variables
Comparison of OS and DFS based on FAR
Independent predictors of OS
Variables | Overall survival | |||
---|---|---|---|---|
Univariable | Multivariable | |||
HR (95% CI) | p value | HR (95% CI) | p value | |
Age (years) | 0.988 (0.980, 0.996) | 0.003 | 0.992 (0.984,1.000) | 0.050 |
Male sex | 1.442 (1.085, 1.917) | 0.012 | 1.293 (0.967, 1.729) | 0.083 |
Positive HBsAg | 1.320 (0.995, 1.751) | 0.054 | ||
Positive anti-HCV | 0.634 (0.263, 1.531) | 0.311 | ||
Child–Pugh grade B | 1.340 (0.962, 1.886) | 0.084 | ||
AFP ≥ 400 ng/mL | 1.767 (1.482, 2.107) | < 0.001 | 1.346 (1.120, 1.618) | 0.002 |
FAR | 1.961 (1.632, 2.355) | < 0.001 | 1.230 (1.001, 1.510) | 0.048 |
NLR | 1.936 (1.611, 2.326) | < 0.001 | 1.045 (0.801, 1.362) | 0.748 |
PLR | 1.839 (1.466, 2.307) | < 0.001 | 0.739 (0.548, 0.998) | 0.049 |
MLR | 1.945 (1.632, 2.319) | < 0.001 | 1.166 (0.940, 1.446) | 0.163 |
SII | 2.210 (1.809, 2.700) | < 0.001 | 1.455 (1.053, 2.010) | 0.023 |
CSPH | 1.390 (1.050, 1.840) | 0.021 | 1.369 (1.022, 1.833) | 0.035 |
Ascites | 1.471 (1.149, 1.883) | 0.002 | 1.186(0.914, 1.539) | 0.198 |
Cirrhosis | 1.085 (0.910, 1.294) | 0.364 | ||
Tumor size ≥ 5 cm | 2.708 (2.200, 3.334) | < 0.001 | 1.500 (1.180, 1.907) | 0.001 |
Multiple number | 1.093 (0.871, 1.371) | 0.441 | ||
MVI | 3.484 (2.920, 4.156) | < 0.001 | 1.522 (0.711, 3.256) | 0.279 |
BCLC stage C | 8.773 (3.619, 21.267) | < 0.001 | 2.693 (0.835, 8.686) | 0.097 |
Blood loss ≥ 400 ml | 2.028(1.701, 2.417) | < 0.001 | 1.232 (1.011, 1.501) | 0.039 |
Blood transfusion | 1.554 (1.225, 1.971) | < 0.001 | 1.083 (0.843, 1.392) | 0.534 |
Major hepatectomy | 1.792 (1.498, 2.143) | < 0.001 | 1.075 (0.881, 1.311) | 0.477 |
Independent predictors of DFS
Variables | Disease-free survival | |||
---|---|---|---|---|
Univariable | Multivariable | |||
HR (95% CI) | p value | HR (95% CI) | p value | |
Age (years) | 0.988 (0.982, 0.994) | < 0.001 | 0.994 (0.987, 1.001) | 0.078 |
Male sex | 1.292 (1.033, 1.616) | 0.025 | 1.170 (0.927, 1.478) | 0.187 |
Positive HBsAg | 1.603 (1.259, 2.041) | < 0.001 | 1.509 (1.167, 1.951) | 0.002 |
Positive anti-HCV | 0.775 (0.415, 1.447) | 0.424 | ||
Child–Pugh grade B | 1.167 (0.870, 1.565) | 0.302 | ||
AFP ≥ 400 ng/mL | 1.560 (1.351, 1.801) | < 0.001 | 1.277 (1.095, 1.489) | 0.002 |
FAR | 1.534 (1.311, 1.796) | < 0.001 | 1.211 (1.014, 1.445) | 0.035 |
NLR | 1.542 (1.318, 1.803) | < 0.001 | 1.086 (0.866, 1.362) | 0.474 |
PLR | 1.646 (1.350, 2.008) | < 0.001 | 0.970 (0.744, 1.265) | 0.821 |
MLR | 1.453 (1.257, 1.679) | < 0.001 | 1.055 (0.878, 1.267) | 0.568 |
SII | 1.676 (1.402, 2.005) | < 0.001 | 1.143 (0.857, 1.524) | 0.364 |
CSPH | 1.306 (1.033, 1.652) | 0.026 | 1.319 (1.030, 1.689) | 0.028 |
Ascites | 1.303 (1.054, 1.610) | 0.014 | 1.129 (0.903, 1.411) | 0.287 |
Cirrhosis | 1.150 (0.996, 1.328) | 0.056 | ||
Tumor size ≥ 5 cm | 2.024 (1.732, 2.364) | < 0.001 | 1.348 (1.121, 1.620) | 0.001 |
Multiple number | 1.057 (0.876, 1.275) | 0.565 | ||
MVI | 2.222 (1.910, 2.584) | < 0.001 | 0.829 (0.424, 1.622) | 0.584 |
BCLC stage C | 4.951 (2.835, 8.646) | < 0.001 | 3.109 (1.303, 7.416) | 0.011 |
Blood loss ≥ 400 ml | 1.860 (1.609, 2.149) | < 0.001 | 1.338 (1.136, 1.575) | < 0.001 |
Blood transfusion | 1.312 (1.056, 1.629) | 0.014 | 0.951 (0.755, 1.200) | 0.674 |
Major hepatectomy | 1.663 (1.438, 1.924) | < 0.001 | 1.144 (0.972, 1.346) | 0.106 |