J Cancer 2019; 10(10):2299-2311. doi:10.7150/jca.30663

Research Paper

The Prognostic Value of aspartate aminotransferase to lymphocyte ratio and systemic immune-inflammation index for Overall Survival of Hepatocellular Carcinoma Patients Treated with palliative Treatments

Li-Yun Zhao1*, Dong-Dong Yang2*, Xiao-Kun Ma1*, Meng-Meng Liu1*, Dong-Hao Wu1, Xiao-Ping Zhang3, Dan-Yun Ruan1, Jin-Xiang Lin1, Jing-Yun Wen1, Jie Chen1, Qu Lin1, Min Dong1, Jing-Jing Qi2, Pei-Shan Hu2, Zhao-Lei Zeng2, Zhan-Hong Chen1,2✉, Xiang-Yuan Wu1✉

1. Department of Medical Oncology and Guangdong Key Laboratory of Liver Disease, Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China
2. Department of Medical Oncology of Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfengdong Road, Guangzhou, 510060, China
3. Meihua Street Community Health Service Center, Yuexiu District Guangzhou, 510000, China
* These authors contributed equally to this work

Abstract

Background: Lymphocytes were reported to play a significant part in host anticancer immune responses and influence tumour prognosis. Few studies have focused on the prognostic values of aspartate aminotransferase (AST) to lymphocyte ratio (ALRI), aspartate aminotransferase to platelet count ratio index (APRI) and systemic immune-inflammation index (SII) in hepatocellular carcinoma (HCC) treated with palliative treatments.

Methods: Five hundred and ninety-eight HCC patients treated with palliative therapies were retrospectively analysed. We randomly assigned patients into the training cohort (429 patients) and the validation cohort I (169 patients). Receiver operating characteristic (ROC) curves were used to identify the best cut-off values for the ALRI, APRI and SII in the training cohort and the values were further validated in the validation cohort I. Correlations between ALRI and other clinicopathological factors were also analysed. A prognostic nomogram including ALRI was established. We validated the prognostic value of the ALRI, SII and APRI with two independent cohorts, the validation cohort II of 82 HCC patients treated with TACE and the validation cohort III of 150 HCC patients treated with curative resection. In the training cohort and all the validation cohorts, univariate analyses by the method of Kaplan-Meier and multivariate analysis by Cox proportional hazards regression model were carried out to identify the independent prognostic factors.

Results: The threshold values of ALRI, APRI and SII were 86.3, 1.37 and 376.4 respectively identified by ROC curve analysis in the training cohort. Correlation analysis showed that ALRI>86.3 was greatly associated with higher rates of Child-Pugh B&C, portal vein tumor thrombosis (PVTT) and ascites (P < 0.05). Correspondingly, ALRI level of HCC patients with Child-Pugh B&C, PVTT and ascites was evidently higher than that of HCC patients with Child-Pugh A, without PVTT and without ascites (P < 0.001). In the training cohort and the validation cohort I, II, III, the OS of patients with ALRI >86.3 was obviously shorter than patients with ALRI ≤86.3 (P <0.001). We identified ALRI as an independent prognostic factor by univariate and multivariate analyses both in training Cohort (HR=1.481, P=0.004), validation cohort I (HR=1.511, P=0.032), validation cohort II (HR=3.166, P=0.005) and validation cohort III (HR=3.921, P=0.010). The SII was identified as an independent prognostic factor in training cohort (HR=1.356, P=0.020) and the validation cohort II (HR=2.678, P=0.002). The prognostic nomogram including ALRI was the best in predicting 3-month, 6-month, 1-year, 2-year survival And OS among TNM, ALRI, ALRI-TNM and nomogram.

Conclusions: The ALRI was a novel independent prognostic index for the HCC patients treated with palliative treatments.

Keywords: ALRI, palliative treatment, hepatocellular carcinoma, prognostic factors, nomogram

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How to cite this article:
Zhao LY, Yang DD, Ma XK, Liu MM, Wu DH, Zhang XP, Ruan DY, Lin JX, Wen JY, Chen J, Lin Q, Dong M, Qi JJ, Hu PS, Zeng ZL, Chen ZH, Wu XY. The Prognostic Value of aspartate aminotransferase to lymphocyte ratio and systemic immune-inflammation index for Overall Survival of Hepatocellular Carcinoma Patients Treated with palliative Treatments. J Cancer 2019; 10(10):2299-2311. doi:10.7150/jca.30663. Available from http://www.jcancer.org/v10p2299.htm