Prognostic Value Of ALBI Grade Combined With NLR In Postoperative Patients With Hepatocellular Carcinoma

Objective: Hepatocellular carcinoma(HCC)is a common malignant tumor of the digestive tract.Liver resection is the preferred treatment for HCC,yet the prognosis far from satisfactory.Preoperative Albumin-Bilirubin(ALBI)grading and Neutrophil-Lymphocyte ratio(NLR)are two markers commonly used to predict the prognosis of HCC after liver resection.However,each grading has its limitations,and the value of ALBI combining with NLR on predicting HCC patients’ prognosis has never been studied.Therefore,this study aims to investigate the prognostic value of ALBI grade and NLR in patients with HCC undergoing liver resection.Methods: The clinicopathological data of 144 patients who underwent liver resection from January 2013 to January 2017 and whose postoperative pathological results confirmed HCC were collected.To identify the factors that significantly impact the prognosis of HCC patients,we performed the log-rank test in the univariate analysis and multivariate COX proportional hazard model for multivariate analysis,using the significant variables determined in the univariate analysis.For ALBI grade,grade 1 and 2 was defined as 0 and 1 point respectively.For NLR score,the NLR cut-off value was determined as 2.60 according to the receiver operating characteristic(ROC)curve,and the NLR≤2.60 and NLR> 2.60 was scored as 0 and 1 points respectively.In order to determine the ALBI-NLR score,we added ALBI and NLR points together,and categorized HCC patients into group A(0 point,ALBI 1 group-low NLR group),group B(1 point,ALBI 1 group-high NLR group or ALBI 2 group-low NLR group),and group C(2 points,ALBI 2 group-high NLR group).Kaplan-Meier curves were used to evaluate the overall survival of the HCC patients between different ALBI grade,NLR,and ALBI combined with NLR groups.Finally,the ROC curve was plotted to compare the predictive efficacy of ALBI grade,NLR,and ALBI-NLR on the prognosis of HCC patients.The all of the difference of the test results was significant with P <0.05.Results:.Preoperative ALBI grade was associated with tumor size(P <0.001),degree of tumor differentiation(P=0.023),TNM stage(P<0.001),Alanine aminotransferase(ALT)(P=0.018),and alpha-fetoprotein(AFP)(P=0.029)in patients with HCC.Kaplan-Meier survival curve showed that the overall survival rate of patients with HCC with ALBI grade 1 was better than that of ALBI grade 2.The 1-year and 3-year overall survival rates of the two groups were 87.2% and 61.4%,67.7% and 38.6%.(P<0.001).Preoperative NLR was correlated with tumor size(P<0.001)and TNM stage(P=0.012)in patients with HCC.The Kaplan-Meier survival curve showed that the overall survival rate of patients with HCC with low NLR group was better than that of the high NLR group.The 1-year and 3-year survival rates of the two groups were 91.4% and 63.0%,67.2% and 32.9%.the difference was statistically significant(P<0.001).Preoperative ALBI-NLR was associated with liver cirrhosis(P=0.031),Child-Pugh(CP)classification(P=0.005),tumor size(P<0.001),albumin(Albumin,ALB)(P<0.001),Alanine aminotransferase(ALT)(P=0.013)and TNM stage(P<0.001)in patients with HCC.The Kaplan-Meier survival curve showed that the overall survival rate(OS)was best in group A,followed by group B,and worst in group C.Univariate analysis results: degree of tumor differentiation,tumor size,TNM stage,AFP,NLR,ALBI grade,ALBI-NLR were correlated with the prognosis of patients with HCC(all P<0.001).Further multivariate COX regression results: TNM staging,AFP,NLR,ALBI-NLR were independent risk factors for prognosis in patients with HCC(P<0.05).ROC curve results show that ALBI-NLR has the largest area under the curve(AUC),indicating that ALBI-NLR has better predictive power than patients with HCC with ALBI grade or NLR alone.Conclusion: 1.Preoperative ALBI grade,NLR,and ALBI-NLR have good predictive value for the postoperative prognosis of patients with HCC,and they are clinically easy to obtain and objective prognostic related biomarkers.2.NLR and ALBI-NLR are independent risk factors that affect the 3-year overall survival of patients with HCC,and have good predictive value for long-term prognosis of patients with HCC.3.The ALBI-NLR score predicts the long-term prognosis of patients with HCC better than using ALBI grade or NLR alone,which indicates that it is effective and feasible to combine multiple risk factors for postoperative prognosis assessment of patients with HCC,and more combinations can be explored in the future.