J Cancer 2020; 11(17):4947-4956. doi:10.7150/jca.45274

Research Paper

Inflammation Score System using Preoperative Inflammatory Markers to Predict Prognosis for Hepatocellular Carcinoma after Hepatectomy: A Cohort Study

Qinjunjie Chen1*, Fengwei Li1,2*, Chengqian Zhong3*, Yiran Zou1, Zheng Li1, Yuzhen Gao4, Qifei Zou2, Yong Xia1, Kui Wang2✉, Feng Shen1✉

1. Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
2. Department of Hepatic Surgery II, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
3. Longyan First Hospital, Affiliated to Fujian Medical University, Longyan, China.
4. Department of Molecular Diagnosis, Clinical Medical College, Yangzhou University, Jiangsu, China.
*These authors contributed equally to this work.

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Citation:
Chen Q, Li F, Zhong C, Zou Y, Li Z, Gao Y, Zou Q, Xia Y, Wang K, Shen F. Inflammation Score System using Preoperative Inflammatory Markers to Predict Prognosis for Hepatocellular Carcinoma after Hepatectomy: A Cohort Study. J Cancer 2020; 11(17):4947-4956. doi:10.7150/jca.45274. Available from https://www.jcancer.org/v11p4947.htm

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Abstract

Background: This study developed a novel inflammation score system to predict survival outcomes using preoperational inflammatory markers in hepatocellular carcinoma (HCC) after surgery.

Materials and Methods: An inflammation score system was developed using five preoperative inflammatory markers based on the clinical data of 455 HCC patients (training cohort) receiving radical resection in the Eastern Hepatobiliary Surgery Hospital. The system was validated using a cohort from a different hospital (external validation). Kaplan-Meier curves and log-rank test were used to compare the survival of patients with different inflammation scores. A nomogram including inflammation scores for survival prediction was created to exhibit the risk factors of overall survival (OS).

Results: The patients in the low-score group showed better OS and recurrence-free survival (RFS) in the training and external validation cohorts than those from the high-score group. Subgroup analysis showed that compared with patients in the training cohort from the high-score group, stage I (eighth TNM stage) patients in the low-score group exhibited better prognosis results, whereas the findings for Stage II and III patients were different. Multivariate Cox analysis revealed that high inflammation score is an independent risk factor of OS and RFS. The nomogram established using the inflammation score with the C-index value of 0.661 (95% confidence interval=0.624-0.698) revealed a good three- and five-year calibration curves.

Conclusions: The inflammation score system based on five preoperative inflammatory markers well predicted the survival of HCC patients after surgery, especially in those at the early stage (Stage I).

Keywords: inflammatory marker, liver resection, hepatocellular carcinoma, prognosis