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Prognostic significance of systemic inflammation score in patients who undergo hepatic resection for hepatocellular carcinoma

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Abstract

Purpose

Systemic inflammation score (SIS) is a novel prognostic score (0, 1, or 2) for various cancers, based on preoperative serum albumin level and lymphocyte-to-monocyte ratio (LMR); modified SIS (mSIS) uses a different LMR cutoff value and was thought to be a more accurate predictor for cancer prognosis. Here, we assessed the prognostic value of SIS and mSIS in patients who receive hepatic resection for hepatocellular carcinoma (HCC).

Methods

We retrospectively evaluated SIS and mSIS of 314 patients after hepatic resection for HCC, against their clinicopathological factors and outcomes, using receiver operating characteristics (ROC) analysis over time.

Results

Among patients with preoperative SIS 2, significantly more HCC specimens were poorly differentiated (P = 0.0281), larger (P = 0.0006), and had more microscopic vascular invasion (P = 0.0136) than the SIS 0–1 group; the mSIS 2 group also had significantly larger tumors (P = 0.0039) than the mSIS 0–1 group. In ROC analysis, SIS was a better predictor of overall survival (OS) and recurrence-free survival (RFS) than mSIS. The SIS 2 group had shorter OS (P = 0.0015) and RFS (P = 0.0065) than other patients. In multivariate analysis, SIS 2 was an independent risk factor for shorter OS (hazard ratio (HR) 1.53, P = 0.0497) and RFS (HR 1.58, P = 0.0053).

Conclusion

SIS is superior to mSIS in predicting prognosis of patients with HCC. mSIS is not a great predictor of prognosis in resected HCC.

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Abbreviations

AFP:

alpha-fetoprotein

DCP:

des-gamma-carboxyprothrombin

HBs Ag:

hepatitis B surface antigen

HCC:

hepatocellular carcinoma

HCV Ab:

hepatitis C virus antibody

ICGR15 :

indocyanine green retention rate at 15 min

IQR:

interquartile range

LMR:

lymphocyte-to-monocyte ratio

mSIS:

modified systemic inflammation score

NLR:

neutrophil-to-lymphocyte ratio

OS:

overall survival

RFS:

recurrence-free survival

ROC:

receiver operating characteristic

SIS:

systemic inflammation score

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Acknowledgements

We thank Marla Brunker, from Edanz Group (www.edanzediting.com/ac), for editing a draft of this manuscript.

Funding

This study was supported by JSPS KAKENHI, a Grant-in-Aid from the Ministry of Health, Labour and Welfare, Japan (Numbers JP-19K09198). The funding sources had no role in the collection, analysis, or interpretation of the data, or in the decision to submit the article for publication.

Author information

Authors and Affiliations

  1. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Shoichi Inokuchi, Shinji Itoh, Tomoharu Yoshizumi, Akinari Morinaga, Takeo Toshima, Kazuki Takeishi, Yoshihiro Nagao, Noboru Harada, Toru Ikegami & Masaki Mori

  2. Department of Biostatistics, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan

    Mototsugu Shimokawa

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  1. Shoichi Inokuchi
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Contributions

S. Inokuchi participated in the writing of the manuscript. S. Inokuchi, S. Itoh, and T. Yoshizumi participated in the study conception and design. S. Inokuchi, A. Morinaga, T. Toshima, K. Takeishi, Y. Nagao, N. Harada, and T. Ikegami participated in acquisition, analysis, and interpretation of data for the work. S. Itoh and M. Shimokawa participated in drafting the work and revising critically for important intellectual content. M. Mori participated in the review of the manuscript and final approval.

Corresponding authors

Correspondence to Shoichi Inokuchi or Shinji Itoh.

Ethics declarations

Ethics approval

The study was approved by the ethics committee of our hospital, in accordance with ethical guidelines of the Japanese Government (approval number: 2019-234).

Consent to participate and for publication

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare no competing interests.

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Supplementary Information

Supplementary Figure S1.

Patients with higher modified systemic inflammation score (mSIS) had shorter overall survival (OS) and recurrence-free survival (RFS). Kaplan–Meier analyses for RFS (a) and OS (b) of hepatocellular carcinoma patients by mSIS. (PNG 864 kb)

High resolution image (TIFF 857 kb)

Supplementary Figure S2.

Patients whose modified systemic inflammation score (mSIS) were 2 had significantly shorter overall survival (OS) and recurrence-free survival (RFS) than those whose mSIS was 0 or 1. Kaplan–Meier analyses for RFS (a) and OS (b) of patients with hepatocellular carcinoma by mSIS value (0 or 1 vs 2). (PNG 880 kb)

High resolution image (TIFF 857 kb)

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Inokuchi, S., Itoh, S., Yoshizumi, T. et al. Prognostic significance of systemic inflammation score in patients who undergo hepatic resection for hepatocellular carcinoma. Langenbecks Arch Surg 406, 773–779 (2021). https://doi.org/10.1007/s00423-021-02103-1

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