Clinical Research Papers:
Prognostic significance of preoperative aspartate aminotransferase to neutrophil ratio index in patients with hepatocellular carcinoma after hepatic resection
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Fei Ji1,2,3,*, Shunjun Fu1,2,3,*, Zhiyong Guo1,2,3*, Hui Pang4, Dubo Chen5, Xiaoping Wang1,2,3, Weiqiang Ju1,2,3, Dongping Wang1,2,3, Xiaoshun He1,2,3, Yunpeng Hua6 and Baogang Peng6
1 Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P. R. China
2 Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, P. R. China
3 Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, P. R. China
4 Department of Medical Records, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P. R. China
5 Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P. R. China
6 Department of Liver Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P. R. China
* These authors have contributed equally to this work
Baogang Peng, email:
Yunpeng Hua, email:
Xiaoshun He, email:
Keywords: aspartate aminotransferase to neutrophil ratio index, systemic immune-inflammation, hepatocellular carcinoma, prognosis, biomarkers
Received: February 06, 2016 Accepted: July 09, 2016 Published: July 26, 2016
Objectives: Various inflammation-based prognostic scores have been associated with poor survival in patients with hepatocellular carcinoma (HCC), and neutrophils display important roles. However, few studies have illuminated the relationship between preoperative aspartate aminotransferase (AST) to neutrophil ratio index (ANRI) and poor prognosis of HCC. We aimed to clarify the prognostic value of ANRI and evaluate the ability of different inflammation-based prognostic scores such as ANRI, AST to lymphocyte ratio index (ALRI) ,AST to platelet count ratio index (APRI), neutrophil-lymphocyte ratio index (NLR), and platelet-lymphocyte ratio index (PLR).
Methods: Data were collected retrospectively from 303 patients who underwent curative resection for HCC. Preoperative ANRI, ALRI, APRI,NLR, PLR and clinico-pathological variables were analyzed. Univariate, multivariate and Kaplan-Meier analyses were performed to identify the predictive value of the above factors for disease-free survival (DFS) and overall survival (OS).
Results: ANRI was correlated with presence of HBsAg, AST, presence of cirrhosis, tumor size, PVTT, cancer of the liver Italian program (CLIP) score ,recurrence. Univariate analysis showed ANRI, ALRI, APRI, NLR, PLR were significantly associated with DFS and OS in HCC patients with curative resection. After multivariate analysis, ANRI was demonstrated to be superior to ALRI, APRI, NLR, PLR, which were independently correlated with DFS and OS. Survival analysis showed that preoperative ANRI > 7.8 predicted poor prognosis of patients with HCC after hepatectomy. preoperative ANRI also showed different prognostic value in various subgroups of HCC. Furthermore, the predictive range was expanded by the combination of ANRI and NLR.
Conclusions: preoperative ANRI is an independent effective predictor of prognosis for patients with HCC, higher levels of ANRI predict poorer outcomes and the combining ANRI and NLR increases the prognostic accuracy of testing.
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