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Lin KY, Chen QJ, Tang SC, Lin ZW, Zhang JX, Zheng SM, Li YT, Wang XM, Lu Q, Fu J, Guo LB, Zheng LF, You PH, Wu MM, Lin KC, Zhou WP, Yang T, Zeng YY. Prognostic implications of alpha-fetoprotein and C-reactive protein elevation in hepatocellular carcinoma following resection (PACE): a large cohort study of 2770 patients. BMC Cancer 2023; 23:1190. [PMID: 38053048 PMCID: PMC10696803 DOI: 10.1186/s12885-023-11693-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/28/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Routine clinical staging for hepatocellular carcinoma (HCC) incorporates liver function, general health, and tumor morphology. Further refinement of prognostic assessments and treatment decisions may benefit from the inclusion of tumor biological marker alpha-fetoprotein (AFP) and systemic inflammation indicator C-reactive protein (CRP). METHODS Data from a multicenter cohort of 2770 HCC patients undergoing hepatectomy were analyzed. We developed the PACE risk score (Prognostic implications of AFP and CRP Elevation) after initially assessing preoperative AFP and CRP's prognostic value. Subgroup analyzes were performed in BCLC cohorts A and B using multivariable Cox analysis to evaluate the prognostic stratification ability of the PACE risk score and its complementary utility for BCLC staging. RESULTS Preoperative AFP ≥ 400ng/mL and CRP ≥ 10 mg/L emerged as independent predictors of poorer prognosis in HCC patients who underwent hepatectomy, leading to the creation of the PACE risk score. PACE risk score stratified patients into low, intermediate, and high-risk groups with cumulative 5-year overall (OS) and recurrence-free survival (RFS) rates of 59.6%/44.9%, 43.9%/38.4%, and 20.6%/18.0% respectively (all P < 0.001). Increased PACE risk scores correlated significantly with early recurrence and extrahepatic metastases frequency (all P < 0.001). The multivariable analysis identified intermediate and high-risk PACE scores as independently correlating with poor postoperative OS and RFS. Furthermore, the PACE risk score proficiently stratified the prognosis of BCLC stages A and B patients, with multivariable analyses demonstrating it as an independent prognostic determinant for both stages. CONCLUSION The PACE risk score serves as an effective tool for postoperative risk stratification, potentially supplementing the BCLC staging system.
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Affiliation(s)
- Kong-Ying Lin
- Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, China
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350000, China
| | - Qing-Jing Chen
- Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, China
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350000, China
| | - Shi-Chuan Tang
- Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, China
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350000, China
| | - Zhi-Wen Lin
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350000, China
| | - Jian-Xi Zhang
- Department of Hepatobiliary Surgery, Xiamen Hospital, Beijing University of Chinese Medicine, Xiamen, 361000, China
| | - Si-Ming Zheng
- Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Ningbo University, Ningbo, 315000, China
| | - Yun-Tong Li
- Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Xiamen, 361000, China
| | - Xian-Ming Wang
- Department of General Surgery, First Affiliated Hospital of Shandong First Medical University, Shandong, 250014, China
| | - Qiang Lu
- Department of Hepatopancreatobiliary Surgery, Third Hospital of Zhangzhou, Zhangzhou, 363000, China
| | - Jun Fu
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350000, China
| | - Luo-Bin Guo
- Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, China
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350000, China
| | - Li-Fang Zheng
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350000, China
| | - Peng-Hui You
- Biobank in Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350000, China
| | - Meng-Meng Wu
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350000, China
| | - Ke-Can Lin
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350000, China
| | - Wei-Ping Zhou
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Navy Medical University (Second Military Medical University), Shanghai, 200000, China
| | - Tian Yang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Navy Medical University (Second Military Medical University), Shanghai, 200000, China.
| | - Yong-Yi Zeng
- Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, China.
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350000, China.
- Liver Disease Research Center of Fujian Province, Fuzhou, 350000, China.
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Xihong Road 312, Fuzhou, 350025, China.
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Pu Q, Yu L, Wang X, Yan H, Xie Y, Du J, Yang Z. Establishment of Nomogram Model for Minimally Invasive Treatment of Small Hepatocellular Carcinoma Based on CD8+T Cell Counts. Onco Targets Ther 2022; 15:925-940. [PMID: 36068914 PMCID: PMC9441171 DOI: 10.2147/ott.s373631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/22/2022] [Indexed: 01/08/2023] Open
Abstract
Purpose Minimally invasive treatment of small hepatocellular carcinoma (HCC) is the main way of treatment, which can cause the change of HCC immune microenvironment. T lymphocytes are an important part of the immune microenvironment and may be powerful predictors of prognosis. The purpose of this study was to explore the effect of T lymphocytes on the prognosis of HCC and establish a prognostic model. Patients and Methods We conducted a retrospective study of 300 patients with small HCC and developed a clinical prediction model. The selection of modeling variables was performed by combining backward stepwise Cox regression using Akaike’s Information Criteria (AIC) and the Least Absolute Shrinkage and Selection Operator (LASSO) regression. Establish a dynamic nomogram model to predict 1-, 2-, and 3-year overall survival (OS). Receiver operating characteristic curve (ROC curve) was used to verify the model discriminative ability, calibration curve was used to examine the model calibration ability, and decision curve analysis (DCA) was used to evaluate the clinical value. Results The nomogram to predict the OS of small HCC includes the following four variables: aspartate aminotransferase (AST), alpha fetoprotein (AFP), C-reactive protein (CRP) and CD8+T cell counts, represented liver function index, tumor-related index, Inflammatory index and immune-related index, respectively. The area under the receiver operating characteristic curves (AUC) of predicting 1-, 2-, and 3-year overall survival were 0.846, 0.824 and 0.812, and the model was excellent in discrimination, calibration and clinical applicability. Conclusion Our study provides a nomogram based on CD8+T cell counts that can help predict the prognosis of small HCC after minimally invasive treatment, which suggests that T lymphocytes can be used as a prognostic factor for HCC. Larger trials are needed to verify our results.
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Affiliation(s)
- Qing Pu
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Lihua Yu
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Xinhui Wang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Huiwen Yan
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Yuqing Xie
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Juan Du
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
- Correspondence: Juan Du, Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China, Email
| | - Zhiyun Yang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
- Zhiyun Yang, Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China, Tel/Fax +86-10-84322148, Email
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Zhao T. Prognostic assessment of C‑reactive protein and neutrophil to lymphocyte ratio in patients with non-small cell lung cancer. Wien Klin Wochenschr 2022; 134:705-711. [PMID: 35794490 DOI: 10.1007/s00508-022-02049-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/20/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To investigate the prognostic assessment of inflammatory factor serum C‑reactive protein CRP and neutrophil to lymphocyte ratio NLR value in patients with non-small cell lung cancer NSCLC. METHODS A retrospective analysis was conducted for 475 patients with NSCLC who visited our hospital with complete follow-up data from January 2017 to 1 January 2019. The changes of serum CRP, NLR levels in patients with NSCLC of different stages, as well as the changes in the levels of the two indexes before and after chemotherapy in patients with advanced stage were compared using t tests with SPSS19.0 software. Serum CRP and NLR were divided into low and high groups with median intercept values and the relationship between inflammation score index and tumor progression-free survival time (PFS) was analyzed retrospectively. Clinical factors that may affect disease prognosis were included in the proportional hazards (COX) regression model for multifactorial prognostic analysis. RESULTS Pretreatment serum levels of NLR and CRP were significantly higher in non-operated patients relative to preoperative levels in surgical patients. Advanced patients had higher levels of both indexes than locally advanced patients. After chemotherapy, the levels of the two indexes reaching remission were significantly lower than those before chemotherapy. The levels of the two indexes in patients with stable disease after chemotherapy were not statistically significant compared with those before chemotherapy, and the levels of the two indexes in the group with progressive disease after chemotherapy were significantly higher than those before chemotherapy. The results of PFS survival analyses showed that PFS was prolonged in the low score CRP and the low score NLR group, compared with the high score group. Multifactorial prognostic analysis showed that smoking, CRP and NLR were risk factors for PFS prognosis in patients with NSCLC. CONCLUSION Serum CRP and NLR are effective predictors of poor prognosis in patients with NSCLC.
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Affiliation(s)
- Tingting Zhao
- Department of Respiratory and Critical Care Medicine, Zhuji Affiliated Hospital of Shaoxing University, No.9 Jianmin Road, Taozhu Street, 311800, Zhuji City, Shaoxing, Zhejiang, China.
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Ranjbar R, Ghasemian M, Maniati M, Hossein Khatami S, Jamali N, Taheri-Anganeh M. Gastrointestinal disorder biomarkers. Clin Chim Acta 2022; 530:13-26. [DOI: 10.1016/j.cca.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/11/2022] [Accepted: 02/15/2022] [Indexed: 01/19/2023]
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Chen S, Ma W, Shen L, Wu Y, Qi H, Cao F, Huang T, Fan W. Recurrence Beyond the Milan Criteria of HBV-Related Single Hepatocellular Carcinoma of 2-3 cm: Comparison of Resection and Ablation. Front Oncol 2021; 11:757149. [PMID: 34733791 PMCID: PMC8558395 DOI: 10.3389/fonc.2021.757149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/28/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Comparison of patterns of early hepatocellular carcinoma (HCC) recurrence beyond the Milan criteria (HRBM) and identification of the independent risk factors of time to recurrence beyond the Milan criteria (TRBM) after resection or ablation can develop an optimal first-line treatment and provide more opportunities and waiting time for salvage transplantation. METHODS The patterns of HRBM after first-line resection or ablation in 384 patients with single-nodule HBV-associated HCC of 2-3 cm were retrospectively analyzed by one-to-one propensity score matching (PSM) between December 2008 and December 2017. The median TRBM between the resection group and the ablation group was estimated by Kaplan-Meier curves. The Cox regression analysis and binary logistic regression were used for the identification of the independent risk factors of TRBM and the occurrence of HRBM, respectively. The abilities of HRBM and the recurrence to predict overall survival (OS) were compared by the time-dependent receiver operating characteristic curves and estimated area under the curve. RESULTS Of 384 patients enrolled in our study, 260 (67.7%) received resection (resection group) and 124 (32.3%) underwent ablation (ablation group). The median TRBM in the resection group was significantly longer than that in the ablation group before PSM (median, not available vs. 101.4 months, P < 0.001) and after PSM (median, not available vs. 85.7 months, P < 0.001). Cox regression showed ablation, older age, CRP ≥1.81 mg/L, and PLT ≤80 × 109/L were the independent risk factors of TRBM. Binary logistic regression also showed that ablation, CRP ≥1.81 mg/L, and PLT ≤80 × 109/L were the independent risk factors of the occurrence of HRBM. The incidences of various phenotypes of HRBM were not significantly different between the two groups, but the incidence of HRBM at the first recurrence in the ablation group was significantly higher than that in the resection group (P < 0.05). Besides, compared with recurrence, HRBM was a better predictor of OS (P < 0.05). CONCLUSIONS Compared with ablation, resection should be considered as a more appropriate first-line option for patients with single-nodule HBV-associated HCC of 2-3 cm and a more promising bridge for liver transplantation in those patients.
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Affiliation(s)
- Shuanggang Chen
- Department of Oncology, Yuebei People’s Hospital, Shantou University Medical College, Shaoguan, China
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Weimei Ma
- Department of Radiology, the Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Lujun Shen
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Ying Wu
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Han Qi
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Fei Cao
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Tao Huang
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Weijun Fan
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Weijun Fan,
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