Prognostic Significance Of Preoperative Uric Acid-to-lymphocyte Ratio In Early And Middle Stage Hepatocellular Carcinoma Undergoing Surgery Combined With Transarterial Chemoembolization

Hepatocellular carcinoma(HCC)accounts for 85%–90% of primary liver cancers and is one of the main causes of cancer-related death.Its occurrence and development are closely related to inflammation,immunity and metabolism of tumor micro-environment.The key to improve the overall survival of HCC patients is to reduce the recurrence rate of HCC in the early and middle stage because of the poor prognosis of advanced HCC.Transcortical chemoembolization(TACE)is the most commonly used adjuvant therapy for these patients,but the curative effect is often different from person to person.The purpose of this study was to evaluate the prognostic significance of uric acid to lymphacyte ratio(ULR)in the early and middle stage HCC patients undergoing surgery combined with postoperative TACE(p-TACE).A total of 132 patients with HCC were included in this research.Patients were divided into high-and low-level groups based on ULR.The differences in clinical characteristics and survival indicators were compared between the two groups.We also established receiver operating characteristic(ROC)curve to compare the prognostic value of ULR with single index such as uric acid,lymphocyte and albumin.Finally,36 pairs of cases were obtained by applying the propensity score matching(PSM)model to verify the above results.We found that there was a statistical difference between ULR level and tumor size(P<0.01).Multivariate analysis showed that ULR>5.47(P=0.03)and tumor size>5cm(P<0.05)were independent risk factors for overall survival(OS).ULR>5.47(P<0.01)and diabetes(P=0.04)were independent risk factors for progression free survival(PFS)in HCC patients.Survival analysis of the entire cohort and PSM cohort showed that the OS and PFS in the high-level ULR group were significantly shorter than those in the low-level ULR group(log-rank P<0.001).Further ROC curve showed that ULR had higher sensitivity in prognosis than single index.In short,ULR can be used as one of the indicators of prognosis stratification in the early and middle stage HCC patients undergoing surgery combined with p-TACE.Low level of ULR means longer OS and PFS,suggesting that these patients may be more likely to benefit from the p-TACE,which is conducive to the development of individualized and precise medical treatment in the future.