A new laboratory-based algorithm to predict microvascular invasion and survival in patients with hepatocellular carcinoma.
A new laboratory-based algorithm to predict microvascular invasion and survival in patients with hepatocellular carcinoma.
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DOI：
10.1016/j.ijsu.2018.07.011
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发表时间：
2018-09
影响因子：
15.3
通讯作者：
Ying Zhu;Da Xu;Ze Zhang;Jian Dong;Yu Zhou;Wei-wei Zhang;L. Hong;Wenwei Zhu
中科院分区：
文献类型：
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作者：
Ying Zhu;Da Xu;Ze Zhang;Jian Dong;Yu Zhou;Wei-wei Zhang;L. Hong;Wenwei Zhu
研究背景：术前血清炎症标志物与肝细胞癌（HCC）切除术后的生存结局相关。它们是否能预测HCC的微血管浸润（MVI）仍是未知数。本研究旨在评估炎症标志物与MVI的相关性，并开发一种简单，廉价的术前预测模型MVI.MethodsWe开发了一种新的指数，使用常规的实验室检查来预测MVI。该指数是基于对HCC患者的研究开发的，并在一个内部队列和另一个外部队列中进行了验证。采用免疫组化法检测肿瘤中CD8+T细胞的浸润。结果训练队列165例，内部验证队列107例，外部验证队列80例。在训练队列的多变量分析中，碱性磷酸酶（ALP）和淋巴细胞计数是MVI的独立预测因子。因此，开发了ALP与淋巴细胞比率（ALR）。MVI的ALR AUC高于其他常规临床指标。将69.9例HCC患者分为高（≥69.9）组和低（<69.9）组的ALR的最佳截止点。ALR ≥69.9与总体和无病生存结局较差显著相关。在内部和外部队列中验证了ALR的性能。结论ALR是一种简便、准确、经济的预测MVI的方法，是HCC患者预后的独立危险因素。ALR评分高的患者生存结局不佳与肿瘤中CD8+T细胞浸润减少有关。
BackgroundPreoperative serum inflammatory markers have been correlated with survival outcomes after resection of hepatocellular carcinoma (HCC). Whether they can predict microvascular invasion (MVI) in HCC is still unknown. This study aimed to evaluate the association of inflammatory markers with MVI, and develop a simple and inexpensive preoperative prediction model for MVI.MethodsWe developed a novel index using routine laboratory tests to predict MVI. The index was developed based on a study on patients with HCC, and validated in an internal cohort and another external cohort. The infiltration of CD8+T cells in tumors was measured using immunohistochemistry. The prediction accuracy was evaluated with the area under the receiver operating characteristic curve (AUC).ResultsThere were 165 patients in the training cohort, 107 patients in the internal validation cohort and 80 patients in the external validation cohort. On multivariable analysis in the training cohort, alkaline phosphatase (ALP) and lymphocyte count were independent predictors of MVI. Thus, the ALP-to-lymphocyte ratio (ALR) was developed. The AUCs of the ALR for MVI were higher than the other conventional clinical indices. An optimal cutoff point for the ALR of 69.9 stratified HCC patients into the high (≥69.9) and low (<69.9) groups. An ALR ≥69.9 was significantly associated with worse overall and disease-free survival outcomes. The performance of ALR was validated in the internal and in external cohorts. The CD8+T cell counts were significantly higher in HCC in the ALR<69.9 groups.ConclusionALR was a simple, accurate and inexpensive alternative to predict MVI and an independent risk factor of prognosis for HCC patients. The dismal survival outcomes in patients with high ALR scores were related to decreased infiltrations of CD8+T cells in tumors.