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Sustained Systemic Inflammatory Response Predicts Survival in Patients with Hepatocellular Carcinoma After Hepatic Resection

  • Translational Research
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Preoperative systematic inflammatory response, represented by neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), lymphocyte–monocyte ratio (LMR), and C-reactive protein–albumin ratio (CAR), has been associated with long-term outcomes in patients with hepatocellular carcinoma (HCC). However, the impact of sustained systematic inflammatory response after resection remains unclear.

Methods

This study comprised 210 patients who had undergone primary hepatic resection for HCC between 2008 and 2018. Preoperative and postoperative NLR, LMR, and CAR were evaluated, and patients were then classified into three groups according to the status of each marker: persistently high inflammatory state (elevated group), preoperatively low inflammatory state (normal group), and preoperatively high but postoperatively low inflammatory state (normalized group). Multivariate Cox proportional hazard models were conducted to assess disease-free and overall survival, adjusting for potential confounders.

Results

In multivariate analysis, sex (p = 0.002), hepatitis B surface antigen (HBsAg) positivity (p = 0.002), serum α-fetoprotein (AFP) level ≥ 20 ng/mL (p < 0.001), multiple tumors (p < 0.001), microvascular invasion (p = 0.003), type of resection (p = 0.007), and elevated CAR (hazard ratio [HR] 2.40, 95% confidence interval [CI] 1.55–3.73; p < 0.001) were independent and significant predictors of cancer recurrence, while sex (p = 0.05), HBsAg positivity (p = 0.03), serum AFP level ≥20 ng/mL (p = 0.009), multiple tumors (p = 0.03), microvascular invasion (p = 0.006), and elevated CAR (HR 2.10, 95% CI 1.13–3.91; p = 0.02) were independent predictors of overall survival.

Conclusions

Sustained elevated CAR may be an independent and significant indicator of poor long-term outcomes in patients with HCC after hepatic resection, suggesting the interplay of the host’s inflammatory state and tumor recurrence and progression in HCC.

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Acknowledgments

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Funding

This work was supported by JSPS KAKENHI Grant Number JP21K08805, and research grants from the Uehara Memorial Foundation and Japanese Foundation for Multidisciplinary Treatment of Cancer.

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Authors and Affiliations

  1. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan

    Koichiro Haruki MD, PhD, Tomohiko Taniai MD, PhD, Mitsuru Yanagaki MD, Kenei Furukawa MD, PhD, Masashi Tsunematsu MD, PhD, Shinji Onda MD, PhD, Yoshihiro Shirai MD, PhD, Michinori Matsumoto MD, PhD, Norimitsu Okui MD, PhD & Toru Ikegami MD, PhD

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  1. Koichiro Haruki MD, PhD
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  2. Tomohiko Taniai MD, PhD
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  3. Mitsuru Yanagaki MD
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  4. Kenei Furukawa MD, PhD
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  5. Masashi Tsunematsu MD, PhD
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  10. Toru Ikegami MD, PhD
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Correspondence to Koichiro Haruki MD, PhD.

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Disclosure

Koichiro Haruki, Tomohiko Taniai, Mitsuru Yanagaki, Kenei Furukawa, Masashi Tsunematsu, Shinji Onda, Yoshihiro Shirai, Michinori Matsumoto, Norimitsu Okui, and Toru Ikegami declare no conflicts of interest.

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Haruki, K., Taniai, T., Yanagaki, M. et al. Sustained Systemic Inflammatory Response Predicts Survival in Patients with Hepatocellular Carcinoma After Hepatic Resection. Ann Surg Oncol 30, 604–613 (2023). https://doi.org/10.1245/s10434-022-12464-6

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