| Background and objectivePrimary liver cancer(PLC)is the fourth most common tumor and the second leading cause of tumor death in China,of which hepatocellular carcinoma(HCC)accounts for 75%-85%.As for Chinese HCC patients at China Liver Cancer Stage(CNLC)Ⅰ and Ⅱ a,radical resection is the first choice for long-term survival.However,the rate of 5-year tumor recurrence after radical resection of HCC is as high as 50%-70%.Early recurrence is defined as tumor recurrence within 2 years after radical treatment,accounting for more than 70%of recurrent tumors and the prognosis is even worse.Therefore,it is particularly important to evaluate the risk of early recurrence after radical resection of hepatocellular carcinoma and to screen the population at high risk of early recurrence.Albumin-bilirubin Grade(ALBI Grade)is a newly proposed indicator for evaluating liver function in patients with HCC.Some studies have found that it is better than the traditional Child-Pugh score in predicting the prognosis of patients with HCC.In recent years,a large number of studies have shown that some inflammatory markers based on peripheral blood play an important role in predicting the recurrence of HCC.The purpose of this study was to explore the risk factors of early recurrence after radical resection of stage Ⅰ and stage Ⅱ a hepatocellular carcinoma,to clarify the value of systemic inflammatory re-sponse index(SIRI)and ALBI grade in predicting early recurrence after radical resection of hepatocellular carcinoma,and to construct a Nomogram model for predicting early recurrence-free survival after radical resection of hepatocellular carcinoma.To provide a visual individualized reference tool for evaluating the early recurrence of patients with hepatocellular carcinoma after radical resection.Methods1.The clinical,pathological,treatment and follow-up data of patients who had undergone the first radical resection of hepatocellular carcinoma in the First Affiliated Hospital of Zhengzhou University from January 2015 to July 2019 were analyzed retrospectively.2.By drawing the receiver operating characteristic curve(ROC)of each inflammatory marker,the maximum value of Youden index was taken as the optimal cut-off value.The prognostic value was evaluated by comparing the area under the ROC curve(Area under the curve of Receiver operating characteristic curve,AUC)of each inflammatory marker.3.COX proportional hazard model was used for univariate and multivariate analysis to screen the independent risk factors affecting early recurrence after radical resection of HCC.Kaplan Meier method was used to draw the independent risk factors of early recurrence-free survival curve.Log-rank test was performed to compare the differences between groups,and P<0.05 was considered statistically significant.4.Based on the independent risk factors selected by COX proportional hazard model,a nomogram prediction model was established to predict the 2-year recurrence-free survival rate of patients after radical resection of hepatocellular carcinoma.The discrimination of the model was evaluated by concordance index(C index).The calibration curve was drawn for 1000 times by bootstrap self-test to verify the consistency between the prediction of early recurrence-free survival rate and the actual early recurrence-free survival rate of tumor patients.5.Drawing 2-year time-dependent ROC curves of nomogram model,AJCC 8th TNM stage,BCLC stage and CNLC stage,and evaluating the predictive value of each prediction model by comparing the area under each model curve.Results1.NLR=2.49,MLR=0.25,PLR=64.62,SII=336.54,SIRI=0.95,AAR=0.62,APRI=0.13,ALRI=16.28 and ANRI=13.64 were the optimal cut-off values.And the areas under ROC for inflammatory markers were 0.597,0.588,0.518,0.544,0.601,0.538,0.563,0.596 and 0.516,respectively.2.In this study,there were 350(81%)males and 82(19.0%)females after radical HCC resection,ranging in age from 22 to 80 years old,with an average age of 53.43±9.95 years,with a median age of 53 years.Early recurrence occurred in 200 cases(46.3%)after radical resection.Early recurrence occurred in 200 cases(46.3%)after radical resection,including intrahepatic recurrence in 185 cases(92.5%).3.Univariate analysis used by COX proportional hazard model showed that fibrinogen,AFP,ALBI grade,SIRI,NLR,MLR,SII,ALRI,APRI,liver cirrhosis,tumor size,tumor number,Edmondson-Steiner grade of hepatocellular carcinoma and MVI were the risk factors for early recurrence-free survival after radical resection of hepatocellular carcinoma(P all<0.05).Multivariate analysis showed that ALBI grade,SIRI,tumor size,tumor number,Edmondson-Steiner grade of hepatocellular carcinoma and MVI were independent risk factors for early recurrence-free survival after radical resection of hepatocellular carcinoma(P all<0.05).4.Based on ALBI grade,SIRI,tumor diameter,tumor number,Edmondson-Steiner grade of hepatocellular carcinoma and MVI,a new nomogram model was established to predict the early recurrence-free survival rate of patients after radical resection of HCC.The C index of the model was 0.707(95%CI,0.69-0.725)and the calibration curve showed that the predicted early recurrence-free survival rate was highly consistent with the actual early recurrence-free survival rate.5.In this study,the areas under the ROC of AJCC 8th TNM stage,BCLC stage and CNLC stage of HCC patients were 0.633,0.557 and 0.616 respectively,which were smaller than the newly built nomogram prediction model(AUC=0.746).ConclusionALBI grade,SIRI,tumor size,tumor number,Edmondson-Steiner grade of hepatocellular carcinoma and MVI are the independent risk factors for early recurrence-free survival after radical resection of stage Ⅰ and stage Ⅱ a hepatocellular carcinoma,and the nomogram model based on the above factors can better predict the early recurrence-free survival rate after radical resection of HCC. |
