Prognostic value and association of sarcopenic obesity and systemic inflammatory indexes in patients with hepatocellular carcinoma following hepatectomy and the establishment of novel predictive nomograms

Journal of Gastrointestinal Oncology

article

Chengyu Liao¹  Yifeng Tian¹  Shi Chen¹  Ge Li³  Yannan Bai¹  Songqiang Zhou¹  Long Huang¹  Maolin Yan¹  Funan Qiu¹  Jiangzhi Chen³  Yaodong Wang¹ 

[1] Shengli Clinical Medical College of Fujian Medical University, Fujian Medical University;Department of Hepatobiliary Pancreatic Surgery, Fujian Provinvial Hospital;Department of Hepatobiliary Surgery, Union Hospital, Fujian Medical University

关键词: Hepatocellular carcinoma (HCC);    sarcopenic obesity (SO);    sarcopenia;    inflammatory indexes;    nomogram;    prognostic value;   

DOI  :  10.21037/jgo-20-341

学科分类：肿瘤学

来源: Pioneer Bioscience Publishing Company

【 摘 要 】

Background: The specific impacts of sarcopenic obesity (SO) on hepatocellular carcinoma (HCC) and the association between SO and systemic inflammation remain unclear. This study aimed to investigate the prognostic value and association of SO and systemic inflammation with outcomes after hepatectomy for HCC and develop novel nomograms based on SO and inflammatory indexes for survival prediction. Methods: We retrospectively enrolled 452 patients with HCC who underwent radical hepatectomy between January 2012 and March 2015 in Fujian Provincial Hospital as the training cohort. In addition, 275 patients during the same period were enrolled as the external validation cohort. Patients were classified into different groups according to the presence of sarcopenia and obesity. Different inflammation indexes were evaluated to select the best predictor of overall survival (OS) and recurrence-free survival (RFS). Univariate and multivariate logistic regression were performed to investigate the associations between inflammatory indexes and SO. The inflammatory indexes with the highest predictive values and SO were selected for subgroup analyses to establish a novel classification system: the SOLMR grade. SOLMR grades identified in the multivariate Cox analysis were selected to construct novel nomograms for OS and RFS. Results: SO (P<0.001) was an independent risk factor for OS and RFS. The lymphocyte‐monocyte ratio (LMR) had the highest areas under the receiver operating characteristic (ROC) curves (AUCs) for OS (P<0.001) and RFS (P<0.001) and was identified as an independent factor of SO (P=0.001). SO and the LMR were selected to establish the SOLMR grade. Multivariate Cox analysis revealed that SOLMR grade was a significant independent predictor of OS (P<0.001) and RFS (P<0.001). Nomograms based on SOLMR grades were generated and accurately predicted 1-, 3- and 5-year OS and RFS in HCC patients. The C-index of the novel nomograms was higher than those of the other conventional staging systems (P<0.001). Conclusions: Both SO and the LMR were independent risk factors for OS and RFS in HCC patients after hepatectomy. The LMR was an independent factor of SO. The novel nomograms developed from the SOLMR grading system combining SO with the LMR provide good prognostic estimates of the outcomes of HCC patients.

【 授权许可】

Unknown