Monocyte-to-High-Density Lipoprotein-Cholesterol Ratio Predicts Prognosis of Hepatocellular Carcinoma in Patients with Metabolic-Associated Fatty Liver Disease

Figures & data

Figure 1 Patients selection flow diagram.

Abbreviations: HCC, hepatocellular carcinoma; NBNC-HCC, non-B and non-C hepatocellular carcinoma; MAFLD, metabolically associated fatty liver disease.

Table 1 Baseline Characteristics of Patients with MAFLD-HCC

Baseline Characteristic	Training Cohort (N=112)	Internal Validation Cohort (N=37)	P value
Age, years	61.88±10.30	62.59±9.89	0.710
Gender			0.876
Male, n (%)	68 (60.7)	23 (62.2)
Female, n (%)	44 (39.3)	14 (37.8)
Cigarette smoking, n (%)	13 (11.6)	2 (5.4)	0.277
Alcohol consumption, n (%)	12 (10.7)	4 (10.8)	0.987
Diabetes, n (%)	89 (79.5)	29 (78.4)	0.889
Hypertension, n (%)	24 (21.4)	10 (27.0)	0.482
Cirrhosis, n (%)	78 (69.6)	30 (81.1)	0.177
Ascites, n (%)	54 (48.2)	24 (64.9)	0.079
Macrovascular invasion*, n (%)	23 (20.5)	9 (24.3)	0.627
Extrahepatic metastases*, n (%)	27 (24.1)	8 (21.6)	0.757
AFP, ng/mL (%)			0.382
≤20	69 (61.6)	18 (48.6)
20–400	7 (6.3)	3 (8.1)
≥400	36 (32.1)	16 (43.2)
BCLC staging system, n (%)
A	20 (17.9)	5 (13.5)
B	27 (24.1)	12 (32.4)
C	51 (45.5)	17 (45.9)
D	14 (12.5)	3 (8.1)
ALBI grade, n (%)
1	21 (18.8)	9 (24.3)
2	73 (65.2)	14 (37.8)
3	18 (16.1)	14 (37.8)
ALBI grade	−1.99±0.74	−1.87±0.94	0.457
BMI (kg/m^2)	24.19±3.97	23.92±4.21	0.720
ALT (U/L)	66.09±71.87	61.15±71.41	0.717
AST (U/L)	106.24±137.43	102.78±106.33	0.889
ALB (g/L)	36.07±6.54	35.10±8.83	0.479
TB (umol/L)	84.69±118.89	89.74±105.73	0.818
DB (umol/L)	60.03±91.84	65.06±83.87	0.768
LDH (U/L)	387.43±327.96	373.30±333.19	0.821
γ-GT (U/L)	198.50±168.66	256.52±279.35	0.131
CRP (mg/L)	27.81±22.82	28.30±17.98	0.906
UREA (mmol/L)	8.33±6.20	9.01±5.53	0.555
CRE (umol/L)	86.20±48.46	87.51±51.30	0.889
TG (mmol/L)	1.37±0.75	1.38±0.76	0.932
HDL-C (mmol/L)	0.78±0.36	0.69±0.40	0.172
LDL-C (mmol/L)	3.07±1.23	3.06±1.73	0.971
WBC (10^9/L)	8.07±6.04	7.78±5.03	0.795
RBC (10^12/L)	3.67±0.64	3.60±0.60	0.546
HGB (g/L)	113.31±22.86	114.7±19.94	0.742
PLT (10^9/L)	174.49±109.96	159.74±93.30	0.465
Monocyte Count (10^9/L)	0.44±0.26	0.39±0.25	0.382
Neutrophil Count (10^9/L)	5.64±4.37	5.64±5.00	0.996
Lymphocyte Count (10^9/L)	1.33±1.00	1.23±0.79	0.558
NLR	5.60±4.14	5.70±4.71	0.900
MHR	1.30±2.03	1.89±2.89	0.176
NγLR	1327.65±1931.06	1388.63±1703.99	0.864
OS (months)	17.61±10.75	18.76±17.61	0.635

Notes: Data are presented as mean ± standard deviation. * Images were obtained from contrast-enhanced Computed Tomography or contrast-enhanced magnetic resonance imaging.

Abbreviations: AFP, alpha fetoprotein; BCLC, Barcelona Clinic Liver Cancer; ALBI, albumin-bilirubin; BMI, body mass index; ALT, alanine aminotransferase; AST, aspartate aminotransferase; TP, total protein; ALB, albumin; TB, total bilirubin; DB, direct bilirubin; LDH, lactate dehydrogenase; γ-GT, gamma-glutamyl transpeptidase; CRP, C-reactive protein; CRE, creatinine; TG, triglyceride; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; WBC, white blood cell; RBC, red blood cell; HGB, hemoglobin; PLT, platelet; NLR, neutrophil to lymphocyte ratio; MHR, monocyte -to-HDL ratio; NγLR, neutrophil times g-glutamyl transpeptidase to lymphocyte ratio; OS, Overall Survival.

Table 2 Univariate Cox Regression Analysis of Risk Factors of Survival in Training Cohort

Variable	HR	95% CI	P value
Diabetes	2.365	1.411–3.966	0.001
Extrahepatic metastases	2.655	1.676–4.205	<0.001
Macrovascular invasion	2.829	1.744–4.588	<0.001
BCLC Staging
A	REF
B	2.629	1.350–5.120	0.004
C	7.519	3.908–14.464	<0.001
D	28.938	12.342–67.853	<0.001
ALT	1.005	1.002–1.008	0.001
AST	1.003	1.002–1.005	<0.001
TP	0.949	0.909–0.990	0.016
ALB	0.968	0.938–0.999	0.046
ALBI Grade	1.541	1.168–2.032	0.002
ALBI Grade
1	REF
2	1.563	0.927–2.636	0.094
3	3.252	1.676–6.039	<0.001
TB	1.003	1.002–1005	<0.001
CRP	1.017	1.009–1.025	<0.001
LDH	1.001	1.000–1.001	0.006
γ-GT	1.002	1.001–1.003	0.001
UREA	1.096	1.049–1.146	<0.001
CRE	1.007	1.002–1.012	0.008
MHR	1.368	1.244–1.503	<0.001
WBC	1.061	1.030–1.092	<0.001
PLT	1.002	1.000–1.004	0.028
Monocyte Count	4.110	1.885–8.957	<0.001
Neutrophil Count	1.090	1.042–1.139	<0.001
AFP
≤20	REF
20–400	1.931	0.871–4.280	0.105
≥400	1.559	1.020–2.381	0.040

Abbreviations: HR, hazard ratio; CI, confidence interval; BCLC, Barcelona Clinic Liver Cancer; REF, reference; ALT, alanine aminotransferase; AST, aspartate aminotransferase; TP, total protein; ALB, albumin; ALBI, albumin-bilirubin; TB, total bilirubin; CRP, C-reactive protein; LDH, lactate dehydrogenase; γ-GT, gamma-glutamyl transpeptidase; CRE, creatinine; MHR, monocyte -to-HDL ratio; WBC, white blood cell; PLT, platelet; AFP, alpha fetoprotein.

Table 3 Multivariate Cox Regression Analyses of Risk Factors of Survival in Training Cohort

Variable	HR	95% CI	P value
Extrahepatic metastases	2.014	1.077–3.766	0.028
Macrovascular invasion	2.075	1.068–4.03	0.031
BCLC staging system
A	REF
B	2.369	1.091–5.144	0.029
C	4.449	1.957–10.114	<0.001
D	26.473	7.978–87.843	<0.001
ALBI Grade
1	REF
2	4.807	1.498–15.427
3	11.687	1.625–84.029	0.015
CRP	1.018	1.006–1.030	0.003
LDH	0.998	0.997–1.004	0.003
MHR	1.491	1.240–1.791	<0.001

Abbreviations: HR, hazard ratio; CI, confidence interval; BCLC, Barcelona Clinic Liver Cancer; REF, reference; ALBI, albumin-bilirubin; CRP, C-reactive protein; LDH, lactate dehydrogenase; MHR, monocyte -to-HDL ratio.

Figure 2 Nomogram predicting OS in patients with MAFLD-HCC.

Abbreviations: BCLC, Barcelona Clinic Liver Cancer; CRP, C-reactive protein; LDH, lactate dehydrogenase; MHR, monocyte -to-HDL ratio.

Figure 3 The calibration curves for predicting the 1-, 2-, and 3-year nomogram in the training cohort(A) and validation cohort(B).

Figure 4 ROC curve analysis for 1‑, 2‑, and 3‑year in the training cohort(A) and validation cohort(B).

Figure 5 ROC curve analysis of MHR for 1‑year (A), 2‑year (B), and 3‑year (C).

Abbreviations: MHR, monocyte -to-HDL ratio; ROC, receiver operating characteristic; AUC, area under ROC curve.

Figure 6 Kaplan-Meier curve analysis of MHR for 12-month (A), 24-month (B), and 36-month (C).

Abbreviation: MHR, monocyte -to-HDL ratio.

Figure 7 ROC curve analysis of ALBI Grade for 1‑year (A), 2‑year (B), and 3‑year (C).

Abbreviations: ALBI, albumin-bilirubin; ROC, receiver operating characteristic; AUC, area under ROC curve.

Figure 8 Kaplan-Meier curve analysis of ALBI Grade for 12-month (A), 24-month (B), and 36-month (C).

Abbreviation: ALBI, albumin-bilirubin.

Figure 9 ROC curve analysis of MHR-ALBI for 3-year (A); Kaplan-Meier curve analysis of MHR-ALBI for 12-month (B), 24-month (C), and 36-month (D).

Abbreviations: MHR, monocyte -to-HDL ratio; ALBI, albumin-bilirubin; ROC, receiver operating characteristic; AUC, area under ROC curve.