Combining Preoperative and Postoperative Inflammatory Indicators Can Better Predict the Recurrence of Hepatocellular Carcinoma After Partial Hepatectomy

Figures & data

Figure 1 Selection of patients included in the analysis.

Table 1 Clinicopathological Features of HCC Patients

Variable	Cohort (n=88)
Gender (male)	62 (70.50%)
Age (>60 year)	37 (42%)
HBsAg (positive)	68 (77.3%)
Tumor size (>5 cm)	40 (45.5%)
BCLC stage
0	12 (13.6%)
A	60 (68.2%)
B	7 (8.0%)
C	9 (10.2%)
Tumor number (Multiple)	16 (18.2%)
Tumor differentiation (poor)	11 (12.5%)
MVI (present)	28 (31.8%)
Liver cirrhosis (present)	37 (42.0%)
Tumor necrosis (yes)	40 (45.5%)
Satellite nodules (present)	7 (8.0%)
Capsule invasion (present)	53 (60.2%)
AFP (>20 ng/mL)	64 (72.7%)
PreNLR*	1.84 (0.65–8.66)
PredNLR*	1.40 (−0.17–2.27)
PrePLR*	101.03 (29.05–666.67)
PrePNI*	48.13 (36.45–64.10)
PreLMR*	3.34 (0.94–8.35)
PostNLR*	3.06 (0.83–14.81)
PostdNLR*	1.63 (1.22–3.31)
PostPLR*	127.14 (31.19–642.86)
PostPNI*	42.30 (7.76–60.85)
PostLMR*	2.14 (0.80–5.34)

Note: *Data are presented as medians (range).

Abbreviations: AFP, alpha-fetoprotein; BCLC, Barcelona Clinic Liver Cancer stage; HBsAg, hepatitis B surface antigen; MVI, microvascular invasion; prePLR, preoperative platelet-lymphocyte ratio; preLMR, preoperative lymphocyte-monocyte ratio; prePNI, preoperative prognostic nutritional index; preNLR, preoperative neutrophil-lymphocyte ratio; predNLR, preoperative derived neutrophil-lymphocyte ratio; postPLR, postoperative platelet-lymphocyte ratio; postLMR, postoperative lymphocyte-monocyte ratio; postPNI, postoperative prognostic nutritional index; postNLR, postoperative neutrophil-lymphocyte ratio; postdNLR, postoperative derived neutrophil-lymphocyte ratio.

Table 2 Optimal Cutoff Values for Preoperative and Postoperative Inflammation Indicators

Variable	High	Low
PreNLR	>3.22 (12.5%)	≤ 3.22 (87.5%)
PredNLR	>1.29 (79.5%)	≤1.29 (20.5%)
PrePLR	>61.07 (88.6%)	≤61.07 (11.4%)
PrePNI	>44.35 (58.0%)	≤44.35 (22.7%)
PreLMR	>2.16 (90.9%)	≤2.16 (9.1%)
PostNLR	>3.25 (43.2%)	≤3.25 (56.8%)
PostdNLR	>1.44 (88.6%)	≤1.44 (11.4%)
PostPLR	>91.53 (71.6%)	≤91.53 (28.4%)
PostPNI	>41.75 (58.0%)	≤41.75 (42%)
PostLMR	>2.48 (23.9%)	≤2.48 (76.1%)

Abbreviations: prePLR, preoperative platelet-lymphocyte ratio; preLMR, preoperative lymphocyte-monocyte ratio; prePNI, preoperative prognostic nutritional index; preNLR, preoperative neutrophil-lymphocyte ratio; predNLR, preoperative derived neutrophil-lymphocyte ratio; postPLR, postoperative platelet-lymphocyte ratio; postLMR, postoperative lymphocyte-monocyte ratio; postPNI, postoperative prognostic nutritional index; postNLR, postoperative neutrophil-lymphocyte ratio; postdNLR, postoperative derived neutrophil-lymphocyte ratio.

Figure 2 Kaplan‑Meier survival curves of DFS based on preoperative inflammatory indicators. (A) preNLR, (B) predNLR, (C) preLMR, (D) prePLR, (E) prePNI.

Figure 3 Kaplan‑Meier survival curves of DFS based on postoperative inflammation indicators. (A) postNLR, (B) postdNLR, (C) postLMR, (D) postPLR, (E) postPNI.

Table 3 Univariate and Multivariate Analysis of DFS

Variable	Univariate		Multivariate (Combined Model)
	HR (95% CI)	P	HR (95CI%)	P
Gender (male)	1.437 (0.748–2.758)	0.276
Age (>60 year)	0.902 (0.510–1.595)	0.722
HBsAg (positive)	1.604 (0.749–3.434)	0.224
Tumor size (>5 cm)	1.550 (0.884–2.719)	0.126
Tumor number (Multiple)	2.227 (1.149–4.318)	0.018	3.378 (1.603–7.117)	0.001
Tumor differentiation (poor)	1.757 (0.851–3.629)	0.128
MVI (present)	1.830 (1.020–3.281)	0.043
Liver cirrhosis (present)	1.105 (0.628–1.945)	0.729
Tumor necrosis (yes)	1.314 (0.747–2.309)	0.343
Satellite nodules (present)	2.518 (1.063–5.966)	0.036
Capsule invasion (present)	1.247 (0.697–2.230)	0.457
AFP (>20 ng/mL)	2.188 (1.059–4.517)	0.034	3.340 (1.561–5.576)	0.002
PreNLR (high)	2.590 (1.244–5.392)	0.011
PredNLR (high)	2.832 (1.122–7.153)	0.028
PrePLR (low)	0.455 (0.211–0.977)	0.043	0.231 (0.099–0.538)	0.001
PrePNI (low)	0.412 (0.226–0.754)	0.004	0.281 (0.143–0.554)	<0.001
PreLMR (low)	0.422 (0.188–0.948)	0.037
PostNLR (high)	2.403 (1.360–4.248)	0.003	3.580 (1.906–6.725)	<0.001
PostdNLR (high)	8.562 (1.181–62.087)	0.034
PostPLR (low)	0.720 (0.396–1.310)	0.282
PostPNI (low)	0.457 (0.256–0.815)	0.008
PostLMR (low)	0.260 (0.103–0.657)	0.004

Abbreviations: AFP, alpha-fetoprotein; CI, confidence interval; HR, hazard ratio; HBsAg, hepatitis B surface antigen; MVI, microvascular invasion; prePLR, preoperative platelet-lymphocyte ratio; preLMR, preoperative lymphocyte-monocyte ratio; prePNI, preoperative prognostic nutritional index; preNLR, preoperative neutrophil-lymphocyte ratio; predNLR, preoperative derived neutrophil-lymphocyte ratio; postPLR, postoperative platelet-lymphocyte ratio; postLMR, postoperative lymphocyte-monocyte ratio; postPNI, postoperative prognostic nutritional index; postNLR, postoperative neutrophil-lymphocyte ratio; postdNLR, postoperative derived neutrophil-lymphocyte ratio.

Table 4 Multivariate Analysis of Preoperative and Postoperative Models

Variable	Preoperative Model		Postoperative Model
	HR (95% CI)	P	HR (95CI%)	P
Tumor number (multiple)	2.731 (1.303–5.727)	0.008	2.336 (1.156–4.721)	0.018
Satellite nodules (present)			2.565 (1.051–6.259)	0.038
AFP (>20 ng/mL)	2.294 (1.020–5.160)	0.045	2.229 (1.036–4.798)	0.040
PrePLR (low)	0.236 (0.101–0.553)	0.001
PrePNI (low)	0.338 (0.168–0.682)	0.002
PreLMR (low)	0.331 (0.132–0.825)	0.018
PostNLR (high)			3.189 (1.736–5.860)	<0.001

Abbreviations: AFP, alpha-fetoprotein; CI, confidence interval; HR, hazard ratio; prePLR, preoperative platelet-lymphocyte ratio; prePNI, preoperative prognostic nutritional index; preLMR, preoperative lymphocyte-monocyte ratio; postNLR, postoperative neutrophil-lymphocyte ratio.

Figure 4 Nomogram of the preoperative model.

Figure 5 Calibration curve of the preoperative model for (A) 2 years and (B) 3 years.

Figure 6 Nomogram of the postoperative model.

Figure 7 Calibration curve of the postoperative model for (A) 2 years and (B) 3 years.

Figure 8 Nomogram of the combined model.

Figure 9 Calibration curve of the combined model for (A) 2 years and (B) 3 years.

Figure 10 Different independent prognostic factors of the combined model and the area under the time-dependent ROC for predicting (A) 2-year and (B) 3-year DFS.

Figure 11 Different models and the area under the time-dependent ROC for predicting (A) 2-year and (B) 3-year DFS.