Prognostic value of preoperative systemic immune-inflammation index/albumin for patients with hepatocellular carcinoma undergoing curative resection

Abstract

Background: Hepatocellular carcinoma (HCC) is a major factor for cancer-associated mortality globally. Although the systemic immune-inflammation index (SII) and albumin (ALB) show individual prognostic value for various cancers, their combined significance (SII/ALB) in HCC patients undergoing curative hepatectomy is still unknown. It is hypothesized that a higher SII/ALB ratio correlates with poorer outcomes with regard to overall survival (OS) and recurrence-free survival (RFS).

Aim: To investigate the effect of preoperative SII/ALB in predicting the prognosis of HCC patients undergoing hepatectomy.

Methods: Patients who received curative surgery for HCC at a single institution between 2014 and 2019 were retrospectively analyzed. Cox proportional hazards models and Kaplan-Meier curves were utilized to estimate OS and RFS. A nomogram was created using prognostic factors determined by the least absolute shrinkage and selection operator method and analyzed using multivariate Cox regression. This nomogram was assessed internally through the calibration plots, receiver operating characteristic (ROC) analysis, decision curve analysis (DCA) and the concordance index (C-index).

Results: This study enrolled 1653 HCC patients. Multivariate analyses demonstrated that SII/ALB independently predicted OS [hazard ratio (HR) = 1.22, 95%CI: 1.03-1.46, P = 0.025] and RFS (HR = 1.19, 95%CI: 1.03-1.38, P = 0.022). Age, alpha-fetoprotein, hepatitis B surface antigen, albumin-bilirubin grade, tumor diameter, portal vein tumor thrombus, tumor number, and SII/ALB were incorporated into the nomogram to predict OS. The nomogram had a C-index of 0.73 (95%CI: 0.71-0.76) and 0.71 (95%CI: 0.67-0.74) for the training and validation cohorts, respectively. The area under the ROC curve, DCA and calibration curves demonstrated high accuracy and clinical benefits.

Conclusion: The SII/ALB may independently predict outcomes in HCC patients who receive curative surgical treatment. In addition, the nomogram can be used in HCC treatment decision-making.

Keywords: Hepatocellular carcinoma; Inflammation; Liver resection; Prognosis; Systemic immune-inflammation index/albumin.