| Background: Elevated plasma fibrinogen or systemic inflammatory response index（SIRI）has been reported to be associated with poor prognosis in several cancers.Fibrinogen and systemic inflammatory response index（F-SIRI）have been shown to be valuable tools for predicting the prognosis of gastric cancer.We wished to evaluate the value of preoperative F-SIRI levels for the prognosis of hepatocellular carcinoma（HCC）patients after hepatectomy.Hepatocellular carcinoma（HCC）is one of the most common cancers in the world.In contrast to the observed decline in mortality from other common cancers,such as breast,lung,and prostate cancer,mortality from hepatocellular carcinoma continues to increase at a rate of approximately 2-3% per year.Because hepatocellular carcinoma is difficult to detect at an early stage and has a poor prognosis.Surgical resection and liver transplantation are considered to be the optimal strategies for hepatocellular carcinoma treatment,but most patients have already entered the advanced stage of hepatocellular carcinoma at the time of initial diagnosis,thereby losing the chance of curative treatment.The main reason for this is that patients with early-stage hepatocellular carcinoma usually have no obvious symptoms or have a small tumor size,which are the reasons that difficult to detect.Alpha fetoprotein（AFP）,as a major serum marker,is still far from satisfactory for early hepatocellular carcinoma detection due to insufficient sensitivity and specificity.Using 20 ng / ml as a cutoff value,AFP has been reported to have a sensitivity of 41% to65% and a specificity of 80% to 94% for hepatocellular carcinoma of any stage in patients with cirrhosis.In the early stages of hepatocellular carcinoma progression,the detection rate is as low as 1 / 3.The reason AFP is limited in practice is that 80% of small hepatocellular carcinoma cases do not show elevated serum AFP.There is a disadvantage of low sensitivity in clinical analysis.Useful biomarkers for surveillance and early hepatocellular carcinoma diagnosis are still insufficient.By contrast,hepatocellular carcinoma biomarkers for prognostic or predictive purposes have a stronger clinical role.Studies have shown that preoperative fibrinogen levels are an independent risk factor for postoperative disease-free survival and overall survival in patients with hepatocellular carcinoma,and higher levels of fibrinogen predict a worse outcome.The systemic inflammatory response index（SIRI）is also a convenient,low-cost,and reliable predictor of prognosis in patients with hepatocellular carcinoma.Comprehensive F-NLR score is an independent prognostic indicator in patients with resectable HCC.The study of these biomarkers of hepatocellular carcinoma helps us to understand the influence of some factors on the prognosis of patients and provides an important theoretical basis for the diagnosis of hepatocellular carcinoma and the development of individualized treatment regimens after surgery.But at present,there is also a relative lack of robust biomarkers that can help stratify patients at high risk of recurrence.In this study,we evaluated the prognostic value of preoperative F-SIRI levels in hepatocellular carcinoma patients undergoing hepatectomy by retrospective analysis of clinical and follow-up data of patients undergoing hepatectomy at our institution,with a view to playing a role in the future development of personalized schemes for patients with hepatocellular carcinoma and allowing a fraction of patient benefit.Objective: To retrospectively analyze the relationship between F-SIRI levels and disease-free survival and overall survival after hepatectomy in patients with hepatocellular carcinoma,and to evaluate the prognostic value of F-SIRI for patients with hepatocellular carcinoma after hepatectomy,in the hope of finding a predictive tool that effectively reflects the prognosis of patients with hepatocellular carcinoma.Methods: The clinical data of 602 hepatocellular carcinoma patients who underwent hepatectomy and had postoperative pathologically confirmed HCC in our hospital from January 2015 to December 2017 were collected,and according to the established inclusion and exclusion criteria,298 hepatocellular carcinoma patients were finally included and their clinical data and relevant follow-up data were retrospectively analyzed.F-SIRI was calculated from preoperative fibrinogen levels and Siri data of peripheral blood.Statistical analysis was performed using SPSS 20.0（IBM,Armonk,NY,USA）and R（3.2.3）with the "" RMS "" package.Survival analysis was performed by the Kaplan Meier method and compared by the log rank test.The relationship between F-SIRI and clinicopathological characteristics was analyzed.Univariate and multivariate analyses were performed to determine prognostic factors for disease-free survival（DFS）and overall survival（OS）.A nomogram was constructed based on the multivariate analysis results.Result:1: For 298 patients with hepatocellular carcinoma,151（50.7%）patients had a preoperative F-SIRI score of 0,84（28.2%）patients had a preoperative F-SIRI score of 1,and 63（21.1%）patients had a preoperative F-SIRI score of 2.The preoperative F-SIRI score was correlated（P < 0.05）with tumor diameter,BCLC stage,plasma fibrinogen level,and systemic inflammatory response index（Siri）,but not with other clinical features such as age,gender,tumor number,TNM stage,tumor location,and vascular invasion（P > 0.05）.2: On univariate analysis,the preoperative F-SIRI,type of hepatectomy,tumor diameter,microvascular invasion,albumin level,tumor location,tumor number and BCLC stage were associated with disease-free survival of patients with hepatocellular carcinoma（P <0.05）;On multivariate analysis,microvascular invasion,albumin level,BCLC stage and preoperative F-SIRI score were independent predictors of disease-free survival in patients with hepatocellular carcinoma（P < 0.05）.3: On univariate analysis,the preoperative F-SIRI,type of hepatectomy,tumor diameter,microvascular invasion,albumin level,tumor location,tumor number and BCLC stage were associated with overall survival of patients with hepatocellular carcinoma（P < 0.05）;On multivariate analysis,tumor location,BCLC stage and preoperative F-SIRI score were independent predictors of overall survival in patients with hepatocellular carcinoma（P <0.05）.4: There were significant differences in DFS and OS between patients with different preoperative F-SIRI scores(χ 2 = 57.375,29.105,P < 0.001;A higher score on the F-SIRI is associated with a worse prognosis in patients with hepatocellular carcinoma.Conclusion: Preoperative F-SIRI is an independent prognostic factor for HCC patients after hepatectomy.The higher the F-SIRI score,the worse the patient’s prognosis. |
