Prognostic Significance Of Combined Preoperative S-index And Prognostic Nutrition Index In Patients With Small Hepatocellular Carcinoma And Chronic Hepatitis B

Objective:Non-tumor factors such as chronic inflammation,liver fibrosis,and body immune status are important factors affecting recurrence and long-term survival after hepatocellular carcinoma resection.This study aims to evaluate and compare the value of preoperative fibrosis-4(FIB-4),S-index,and prognostic nutritional index(PNI)to Predict recurrence and long-term survival in patients with small hepatocellular carcinoma and chronic hepatitis B(CHB)who underwent radical resection.Methods:Based on the inclusion and exclusion criteria,We retrospectively analyzed clinical data of 287 patients with small hepatocellular carcinoma and CHB who underwent radical resection at the liver surgery department of Tongji Hospital from January 2013 to December 2015.Univariate and multivariate Cox survival analyses were used to evaluate the prognostic indicators,include S-index,FIB-4,and PNI.The cutoff values for S-index,FIB-4,and S-index were defined by the receiver operating characteristic(ROC)curve analysis.All patients were grouped according to their cutoff values,and the disease-free survival(DFS)and overall survival(OS)were plotted using the Kaplan-Meier method.Results: The follow-up deadline was January 1,2020.A total of 144 patients(50.2%)relapsed,and 88 patients(30.7%)died.According to the ROC curve,the recommended cutoff values of S-index,FIB-4,and PNI were 0.16,2.27,and 44.5,respectively.Liver cirrhosis,BCLC stage A,S-index> 0.16 are independent risk factors for recurrence in patients with small hepatocellular carcinoma and CHB who underwent radical resection(all P<0.05).And tumors with poorly differentiated tumors,PNI<44.5,and S-index>0.16 are risk factors for long-term survival in patients with small hepatocellular carcinoma and CHB who underwent radical resection(all P<0.05).We divided the patients into three groups according to their S-index and PNI status and defined them with different scores.Patients with both low S-index(≤0.16)and high PNI(≥44.5)were given a score of 0 whereas those with one or neither were scored 1 or 2,respectively.The 5-year OS rates were 82.5%,66.3%,and 43.2% for S-index and PNI score=0,1,and 2,respectively(P<0.001).And 5-year DFS rates were 59.8%,44.4% and 31.7% for S-index and PNI score=0,1,and 2,respectively(P<0.001).Conclusion: The S index>0.16 and PNI<44.5 indicate a poor prognosis for patients with small hepatocellular carcinoma and CHB.The combination of S index and PNI can be used as a reference index for clinical prognosis of patients with small hepatocellular carcinoma and CHB.