Serological Risk Index Based on Alpha-Fetoprotein and C-Reactive Protein to Indicate Futile Liver Transplantation Among Patients with Advanced Hepatocellular Carcinoma

Prognostic implications of alpha-fetoprotein and C-reactive protein elevation in hepatocellular carcinoma following resection (PACE): a large cohort study of 2770 patients

BACKGROUND

Routine clinical staging for hepatocellular carcinoma (HCC) incorporates liver function, general health, and tumor morphology. Further refinement of prognostic assessments and treatment decisions may benefit from the inclusion of tumor biological marker alpha-fetoprotein (AFP) and systemic inflammation indicator C-reactive protein (CRP).

METHODS

Data from a multicenter cohort of 2770 HCC patients undergoing hepatectomy were analyzed. We developed the PACE risk score (Prognostic implications of AFP and CRP Elevation) after initially assessing preoperative AFP and CRP's prognostic value. Subgroup analyzes were performed in BCLC cohorts A and B using multivariable Cox analysis to evaluate the prognostic stratification ability of the PACE risk score and its complementary utility for BCLC staging.

RESULTS

Preoperative AFP ≥ 400ng/mL and CRP ≥ 10 mg/L emerged as independent predictors of poorer prognosis in HCC patients who underwent hepatectomy, leading to the creation of the PACE risk score. PACE risk score stratified patients into low, intermediate, and high-risk groups with cumulative 5-year overall (OS) and recurrence-free survival (RFS) rates of 59.6%/44.9%, 43.9%/38.4%, and 20.6%/18.0% respectively (all P < 0.001). Increased PACE risk scores correlated significantly with early recurrence and extrahepatic metastases frequency (all P < 0.001). The multivariable analysis identified intermediate and high-risk PACE scores as independently correlating with poor postoperative OS and RFS. Furthermore, the PACE risk score proficiently stratified the prognosis of BCLC stages A and B patients, with multivariable analyses demonstrating it as an independent prognostic determinant for both stages.

CONCLUSION

The PACE risk score serves as an effective tool for postoperative risk stratification, potentially supplementing the BCLC staging system.

Establishment of Nomogram Model for Minimally Invasive Treatment of Small Hepatocellular Carcinoma Based on CD8+T Cell Counts

Purpose

Minimally invasive treatment of small hepatocellular carcinoma (HCC) is the main way of treatment, which can cause the change of HCC immune microenvironment. T lymphocytes are an important part of the immune microenvironment and may be powerful predictors of prognosis. The purpose of this study was to explore the effect of T lymphocytes on the prognosis of HCC and establish a prognostic model.

Patients and Methods

We conducted a retrospective study of 300 patients with small HCC and developed a clinical prediction model. The selection of modeling variables was performed by combining backward stepwise Cox regression using Akaike’s Information Criteria (AIC) and the Least Absolute Shrinkage and Selection Operator (LASSO) regression. Establish a dynamic nomogram model to predict 1-, 2-, and 3-year overall survival (OS). Receiver operating characteristic curve (ROC curve) was used to verify the model discriminative ability, calibration curve was used to examine the model calibration ability, and decision curve analysis (DCA) was used to evaluate the clinical value.

Results

The nomogram to predict the OS of small HCC includes the following four variables: aspartate aminotransferase (AST), alpha fetoprotein (AFP), C-reactive protein (CRP) and CD8⁺T cell counts, represented liver function index, tumor-related index, Inflammatory index and immune-related index, respectively. The area under the receiver operating characteristic curves (AUC) of predicting 1-, 2-, and 3-year overall survival were 0.846, 0.824 and 0.812, and the model was excellent in discrimination, calibration and clinical applicability.

Conclusion

Our study provides a nomogram based on CD8⁺T cell counts that can help predict the prognosis of small HCC after minimally invasive treatment, which suggests that T lymphocytes can be used as a prognostic factor for HCC. Larger trials are needed to verify our results.

Prognostic assessment of C‑reactive protein and neutrophil to lymphocyte ratio in patients with non-small cell lung cancer

OBJECTIVE

To investigate the prognostic assessment of inflammatory factor serum C‑reactive protein CRP and neutrophil to lymphocyte ratio NLR value in patients with non-small cell lung cancer NSCLC.

METHODS

A retrospective analysis was conducted for 475 patients with NSCLC who visited our hospital with complete follow-up data from January 2017 to 1 January 2019. The changes of serum CRP, NLR levels in patients with NSCLC of different stages, as well as the changes in the levels of the two indexes before and after chemotherapy in patients with advanced stage were compared using t tests with SPSS19.0 software. Serum CRP and NLR were divided into low and high groups with median intercept values and the relationship between inflammation score index and tumor progression-free survival time (PFS) was analyzed retrospectively. Clinical factors that may affect disease prognosis were included in the proportional hazards (COX) regression model for multifactorial prognostic analysis.

RESULTS

Pretreatment serum levels of NLR and CRP were significantly higher in non-operated patients relative to preoperative levels in surgical patients. Advanced patients had higher levels of both indexes than locally advanced patients. After chemotherapy, the levels of the two indexes reaching remission were significantly lower than those before chemotherapy. The levels of the two indexes in patients with stable disease after chemotherapy were not statistically significant compared with those before chemotherapy, and the levels of the two indexes in the group with progressive disease after chemotherapy were significantly higher than those before chemotherapy. The results of PFS survival analyses showed that PFS was prolonged in the low score CRP and the low score NLR group, compared with the high score group. Multifactorial prognostic analysis showed that smoking, CRP and NLR were risk factors for PFS prognosis in patients with NSCLC.

CONCLUSION

Serum CRP and NLR are effective predictors of poor prognosis in patients with NSCLC.

Recurrence Beyond the Milan Criteria of HBV-Related Single Hepatocellular Carcinoma of 2-3 cm: Comparison of Resection and Ablation

BACKGROUND

Comparison of patterns of early hepatocellular carcinoma (HCC) recurrence beyond the Milan criteria (HRBM) and identification of the independent risk factors of time to recurrence beyond the Milan criteria (TRBM) after resection or ablation can develop an optimal first-line treatment and provide more opportunities and waiting time for salvage transplantation.

METHODS

The patterns of HRBM after first-line resection or ablation in 384 patients with single-nodule HBV-associated HCC of 2-3 cm were retrospectively analyzed by one-to-one propensity score matching (PSM) between December 2008 and December 2017. The median TRBM between the resection group and the ablation group was estimated by Kaplan-Meier curves. The Cox regression analysis and binary logistic regression were used for the identification of the independent risk factors of TRBM and the occurrence of HRBM, respectively. The abilities of HRBM and the recurrence to predict overall survival (OS) were compared by the time-dependent receiver operating characteristic curves and estimated area under the curve.

RESULTS

Of 384 patients enrolled in our study, 260 (67.7%) received resection (resection group) and 124 (32.3%) underwent ablation (ablation group). The median TRBM in the resection group was significantly longer than that in the ablation group before PSM (median, not available vs. 101.4 months, P < 0.001) and after PSM (median, not available vs. 85.7 months, P < 0.001). Cox regression showed ablation, older age, CRP ≥1.81 mg/L, and PLT ≤80 × 10⁹/L were the independent risk factors of TRBM. Binary logistic regression also showed that ablation, CRP ≥1.81 mg/L, and PLT ≤80 × 10⁹/L were the independent risk factors of the occurrence of HRBM. The incidences of various phenotypes of HRBM were not significantly different between the two groups, but the incidence of HRBM at the first recurrence in the ablation group was significantly higher than that in the resection group (P < 0.05). Besides, compared with recurrence, HRBM was a better predictor of OS (P < 0.05).

CONCLUSIONS

Compared with ablation, resection should be considered as a more appropriate first-line option for patients with single-nodule HBV-associated HCC of 2-3 cm and a more promising bridge for liver transplantation in those patients.