Gan Wei, Zhang Mei-Xia, Wang Jia-Xing, Fu Yi-Peng, Huang Jin-Long, Yi Yong, Jing Chu-Yu, Fan Jia, Zhou Jian, Qiu Shuang-Jian
Department of Liver Surgery and Liver Transplantation, Liver Cancer Institute, Zhongshan Hospital and Shanghai Medical School, Fudan University, Key Laboratory for Carcinogenesis and Cancer Invasion, The Chinese Ministry of Education, Shanghai, People's Republic of China,
Biomedical Research Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China,
Cancer Manag Res. 2018 Nov 5;10:5383-5394. doi: 10.2147/CMAR.S176317. eCollection 2018.
Radical resection is the treatment of choice for hepatocellular carcinoma (HCC). However, even with this treatment, HCC prognosis and the efficacy of current predictive models for such patients remain unsatisfactory. Here, we describe an accurate and easy-to-use prognostic index for patients with HCC who have undergone curative resection.
The study population comprised of 1,041 patients with HCC who underwent curative resection at Zhongshan Hospital. This population was reduced to 768 patients who were treated in 2012 analyzed as the training cohort and 273 patients treated in 2007 who were used as a validation cohort.
The lactic dehydrogenase to albumin ratio (LAR) was identified as a significant prognostic index for both overall survival and recurrence-free survival in two independent cohorts. The optimal cutoff value for LAR was determined to be 5.5. The C-index of LAR was superior to other inflammatory scores and serum parameters. This biomarker was also shown to be a stable predictive index in the validation cohort. The new nomogram combining LAR with the Barcelona Clinic Liver Cancer staging system had an improved ability to discriminate overall survival and recurrence-free survival. Nomogram predictions were consistent with observations based on calibration and decisive curve analysis in both independent cohorts.
LAR is a novel, convenient, reliable, and accurate prognostic predictor in patients with HCC undergoing curative resection. Our results suggest the recommendation of LAR to be used in routine clinical practice.
根治性切除是肝细胞癌（HCC）的首选治疗方法。然而，即便采用这种治疗方法，HCC患者的预后以及当前预测模型对此类患者的疗效仍不尽人意。在此，我们描述一种针对接受根治性切除的HCC患者的准确且易于使用的预后指标。
研究人群包括1041例在中山医院接受根治性切除的HCC患者。该人群缩减为2012年接受治疗的768例患者作为训练队列，以及2007年接受治疗的273例患者作为验证队列进行分析。
乳酸脱氢酶与白蛋白比值（LAR）被确定为两个独立队列中总生存期和无复发生存期的显著预后指标。LAR的最佳临界值确定为5.5。LAR的C指数优于其他炎症评分和血清参数。该生物标志物在验证队列中也被证明是一个稳定的预测指标。将LAR与巴塞罗那临床肝癌分期系统相结合的新列线图在区分总生存期和无复发生存期方面具有更强的能力。列线图预测与两个独立队列中基于校准和决策曲线分析的观察结果一致。
LAR是接受根治性切除的HCC患者一种新颖、便捷、可靠且准确的预后预测指标。我们的结果建议将LAR用于常规临床实践。
