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Comparison Between Neutrophil–Lymphocyte Ratio and Systemic Immune-Inflammation Index as Predictors of One-Year Survival in Patients with Untreated Advanced Hepatocellular Carcinoma

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Abstract

Background

Patients with hepatocellular carcinoma (HCC) generally only come for treatment when cancer has reached an advanced stage, with very limited treatment options. There has not been an accurate predictor marker to be able to identify which group of patients may have better survival. This study wanted to analyze the role of the inflammatory status indices as predictors of 1-year survival in patients with advanced HCC who did not undergo therapy.

Methods

This study has a retrospective cohort design using secondary data on subjects with advanced HCC who did not undergo therapy at Cipto Mangunkusumo Hospital and Dharmais Hospital. The neutrophil–lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) were evaluated for their role as predictors of 1-year survival based on the area under receiving operator curve (AUROC). The best optimal cut-off for NLR and SII was decided based on the Youden index, followed by survival analysis based on those cut-offs. Confounding factors were analyzed with multivariate cox regression analysis.

Results

A total of 196 subjects were included in the data analysis. One-year survival was 6.6%, with a median survival of 56 days (95% CI: 46–67). The NLR had a discriminatory ability based on AUROC of 0.667 (95% CI: 0.536–0.798; p = 0.044), with the optimal cut-off point to differentiate survival was 3.7513. The SII has a discriminatory ability based on AUROC of 0.766 (95% CI: 0.643–0.889; p = 0.001), with the optimal cut-off point to distinguish survival was 954.4782. SII had superiority in discriminatory ability (p = 0.0415).

Conclusions

The discriminatory ability based on AUROC of SII was better than that of NLR in predicting 1-year survival in patients with advanced HCC who did not undergo therapy.

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Acknowledgements

We would like to express our gratitude to our advisors, Chyntia Olivia Maurine Jasirwan, Pringgodigdo Nugroho, Dyah Purnamasari, Kuntjoro Harimurti, Rino Alvani Gani, and Iris Rengganis, who gave us constructive input throughout this project.

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Authors and Affiliations

  1. Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/ Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia

    Irsan Hasan & Juferdy Kurniawan

  2. Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia

    Lutfie Lutfie

  3. Division of Medical Oncology Hematology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia

    Ikhwan Rinaldi

  4. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Dharmais National Cancer Center Hospital, Jakarta, Indonesia

    Imelda Maria Loho

Authors
  1. Irsan Hasan
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  2. Lutfie Lutfie
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  4. Juferdy Kurniawan
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  5. Imelda Maria Loho
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Lutfie and Imelda Maria Loho. The first draft of the manuscript was written by Lutfie, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Lutfie Lutfie.

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Ethics Approval

Approval was obtained from the ethics committee of Universitas Indonesia. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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The authors declare no competing interests.

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Hasan, I., Lutfie, L., Rinaldi, I. et al. Comparison Between Neutrophil–Lymphocyte Ratio and Systemic Immune-Inflammation Index as Predictors of One-Year Survival in Patients with Untreated Advanced Hepatocellular Carcinoma. J Gastrointest Canc 54, 135–146 (2023). https://doi.org/10.1007/s12029-021-00796-7

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  • DOI: https://doi.org/10.1007/s12029-021-00796-7

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