The Prognostic And Predictive Value Of Preoperative ALRI And NLR In Patients Who Underwent Resection For HBV-related Hepatocellular Carcinoma

Objective: To investigate the prognostic and predictive value of preoperative aspartate aminotransferase to lymphocyte ratio index(ALRI)and neutrophil to lymphocyte ratio(NLR)in patients who underwent resection for HBV-related hepatocellular carcinoma.Methods : The clinicopathological data of 175 patients with HBV-related HCC(HBV-HCC)undergoing R0 resection from January 2014 to January 2017 were retrospectively analyzed,and the receiver operating characteristic(ROC)curve analysis was performed to determine the best cut-off value of preoperative ALRI for predicting overall survival,and the patients were classified into low ALRI(ALRI < 27.53)and high ALRI groups(ALRI ?27.53).The correlation between each clinicopathological parameter and ALRI was evaluated.The effects of clinicopathological parameters on overall survival(OS)were assessed by univariate analysis using the log-rank test.The significant variables were further analyzed by multivariate Cox regression model.Kaplan-meier survival analysis was used to compare the survival time of patients of the high ALRI group with the low ALRI group,and the log-rank test was used to test the difference.Patients were divided into high NLR group(NLR?2.7)and low NLR group(NLR< 2.7)with the median value of NLR as the critical value to evaluate the correlation between clinicopathological parameters and NLR.The postoperative paraffin specimens of 111 out of 175 patients with HBV-HCC were randomly selected for immunohistochemical analysis to detect the expression of Ki67,and the correlation between NLR and Ki67 expression was analyzed.Kaplan-meier survival analysis was used to compare the survival time of patients in the high NLR group and the low NLR group.The low ALRI or low NLR group was scored 0 point,and the high ALRI or high NLR group was scored 1 point.All groups were divided into low ALRI-NLR group(0 point),medium ALRI-NLR group(1 point),and high ALRI-NLR group(2 points).Kaplan-meier survival analysis was used to evaluate the overall survival of patients with different ALRI-NLR score after R0 resection.The ROC curve was used to compare the prognostic and predictive value of ALRI-NLR,ALRI and NLR in evaluating the prognosis of HBV-HCC after surgical resection.Results: 1.ALRI is related to TNM staging of liver cancer?serum alpha-fetoprotein(AFP),diameter of tumor,preoperative albumin(Alb)concentration,preoperative aspartate aminotransferase(AST),microvascular invasion(MVI).Univariate analysis indicated that preoperative ALRI,the diameter of tumors,the number of tumors,preoperative AFP,preoperative Alb,MVI,AST,TNM staging and differentiation of tumors were the influence factors of overall survival after R0 resection of HBV-HCC(P<0.05).Multivariate analysis indicated preoperative ALRI,MVI,TNM stage III stage were independent prognostic factors for HBV-HCC after R0 resection of HBV-HCC(P < 0.05).Kaplan-meier survival analysis indicated that the lower ALRI group had significantly better OS(P < 0.001).2.NLR is related to TNM staging of liver cancer,AFP,diameter of tumor,MVI.NLR was correlated with Ki67 expression intensity,and the number of correlation coefficient rs=0.264.Patients in the high NLR group had higher Ki67 expression score,and Patients with high Ki67 expression scores had poorer survival than those with low Ki67 expression scores.Patients in the high NLR group had significantly worse survival outcomes than those in the low NLR group.3.The postoperative survival of patients with HBV-HCC evaluated by ALRI combined with NLR is better than that of ALRI or NLR alone.Patients with high ALRI-NLR scores had shorter overall survival than those with low ALRI-NLR scores?Conclusion: 1.Preoperative ALRI is an independent risk factor affecting the overall survival of patients with HBV-associated hepatocellular carcinoma after R0 resection,which may have good clinical value in the postoperative prognosis evaluation of hepatocellular carcinoma.2.Preoperative NLR was correlated with Ki67 expression(rank correlation coefficient rs=0.264),which had a good clinical value in the prognosis evaluation of patients with HBV-related hepatocellular carcinoma after R0 resection.3.Preoperative combination of ALRI and NLR has a better evaluation value for patients with HBV-related hepatocellular carcinoma after R0 resection than alone,and patients with high ALRI-NLR scores have significantly worse survival prognosis.