Prognostic Nutritional Index And Microvascular Invasion On The Prognosis Of Liver Transplant Patients With Hepatocellular Carcinoma

Objective:Liver transplantation is the best treatment option for patients with hepatocellular carcinoma(HCC)who meet the indications for transplantation,but tumour recurrence after transplantation remains a major cause of long-term patient survival.This study analysed the clinicohistopathological characteristics of HCC patients who underwent liver transplantation to evaluate the impact of prognostic nutritional index(PNI)and microvascular invasion(MVI)on patients’ overall survival(OS)and recurrence-free survival(RFS)after surgery.Methods:We retrospectively analyzed 100 HCC patients who underwent liver transplantation at the First Hospital of Jilin University from September 2011 to December 2019.The software SPSS 26.0 and R 4.1.1 were used to perform all statistical analysis for this study.The best truncated values for continuous variables were obtained using the software X-tile 3.6.1.Continuous variables were expressed as mean ± standard deviation and t-tests were used for comparison among groups.Count data were expressed as frequencies(%)and differences betweeen groups were compared using the chi-square test or Fisher’s exact probability test.Prognostic factors associated with OS and RFS were identified by univariate and multifactorial analyseis using Cox proportional regression risk models.Survival curves were plotted using the Kaplan-Meier method and R(ggsurvplot package),and differences between?groups were compared using the log-rank test.Risk ratios and 95% confidence intervals were used to describe relative risk.A two-tailed P < 0.05 was determined to be statistically significant.Result:(1)The 1-and 3-year RFS rates for patients after liver transplantation for hepatocellular carcinoma were 77.8% and 70.3%,and the 1-and 3-year OS rates were 94.0% and 74.8.In the low PNI group,26 out of 68 patients(38.2%)had tumour recurrence at final follow-up;in the high PNI group,4 out of 32patients(12.5%)had tumour recurrence at final follow-up.The post-transplant RFS rate was significantly better in the high PNI group compared to the low PNI group,with a statistically significant difference(P=0.009).The clinicopathological characteristics of patients in both groups were essentially similar,except for statistically significant differences between the MELD score(P=0.004),international normalized ratio(P<0.001),neutrophil-lymphocyte ratio(P=0.011)and platelet-lymphocyte ratio(P=0.048)groups.(2)Univariate analyses of age,gender,primary disease,Milan criteria,MELD score and other clinicopathological variables were performed to investigate factors affecting the prognosis of patients receiving liver transplantation for HCC.Univariate Cox regression analysis suggested that compliance with the Milan criteria,alpha-fetoprotein,fibrinogen,maximum tumour diameter,tumour number,MVI,portal vein tumor thrombus,TNM stage,neutrophil-lymphocyte ratio,platelet-lymphocyte ratio,systemic immune-inflammatory index and PNI were all significantly associated with RFS and OS in HCC patients treated with liver transplantation for liver cancer.(3)In a multifactorial analysis,the results showed that preoperative PNI(HR=0.22,95%CI=0.057-0.840,P=0.027)and MVI(HR=5.79,95%CI=1.454-23.080,P=0.013)were significant prognostic markers affecting RFS.In contrast,only MVI(HR=6.81,95% CI=1.841-25.165,P=0.004)was a significant prognostic marker for OS.(4)Among patients without MVI,the differences in post-transplant OS and RFS rates between patients in the high PNI group and those in the low PNI group were not statistically significant(P=0.27,P=0.12).However,among patients in the MVI group,the difference in post-transplant RFS between patients in the high PNI group and those in the low PNI group was statistically significant(P=0.04);while the difference in post-transplant OS between patients in the high PNI group and those in the low PNI group was not statistically significant(P=0.10).Conclusion:Preoperative PNI and MVI are independent influences on tumour recurrence after liver transplantation for HCC,and a positive MVI is also an independent risk factor for long-term patient survival.In MVI-positive patients,low PNI was associated with tumour recurrence in HCC patients after liver transplantation.