Wang Xiao, Wang Wenjun, Lin Xixiang, Chen Xu, Zhu Mingxiang, Xu Hongli, He Kunlun
Medical Big Data Research Center, Chinese PLA General Hospital, Beijing 100853, China.
Medical School of Chinese PLA, Beijing 100853, China.
Life (Basel). 2023 Sep 29;13(10):1990. doi: 10.3390/life13101990.
Post-hepatectomy liver failure (PHLF) remains a complication with the potential risk of mortality for hepatocellular carcinoma (HCC) patients. The systemic inflammatory response (SIR) has been demonstrated to be associated with a bad prognosis of liver cirrhosis and tumors. This study aims to evaluate the incremental prognostic value of inflammatory markers in predicting PHLF in patients with HCC.
Clinical characteristics and variables were retrospectively collected in 2824 patients diagnosed with HCC who underwent radical hepatectomy from the First Medical Center of the General Hospital of the People's Liberation Army. A recently published prognostic model for PHLF was used as the reference model. The increase in AUC (ΔAUC), integrated discrimination improvement (IDI), and the continuous version of the net reclassification improvement (NRI) were applied for quantifying the incremental value of adding the inflammatory markers to the reference model. A value < 0.05 was considered statistically significant.
The reference PHLF model showed acceptable prediction performance in the current cohort, with an AUC of 0.7492 (95%CI, 0.7191-0.7794). The calculated ΔAUC associated with procalcitonin (PCT) was the only one that was statistically significant ( < 0.05), with a value of 0.0044, and demonstrated the largest magnitude of the increase in AUC. The continuous NRI value associated with the systemic immune-inflammation index (SII) was 35.79%, second only to GPS (46.07%). However, the inflammatory markers of the new models with statistically significant IDI only included WBC count, lymphocyte count, and SII. IDI associated with SII, meanwhile, was the maximum (0.0076), which was consistent with the performance of using the ΔAUC (0.0044) to assess the incremental value of each inflammatory variable.
Among a wide range of inflammatory markers, only PCT and SII have potential incremental prognostic value for predicting PHLF in patients with radical resectable HCC.
肝切除术后肝衰竭（PHLF）仍是肝细胞癌（HCC）患者存在死亡潜在风险的一种并发症。全身炎症反应（SIR）已被证明与肝硬化和肿瘤的不良预后相关。本研究旨在评估炎症标志物在预测HCC患者PHLF方面的增量预后价值。
回顾性收集解放军总医院第一医学中心2824例诊断为HCC并接受根治性肝切除术患者的临床特征和变量。将最近发表的PHLF预后模型作为参考模型。采用曲线下面积增加量（ΔAUC）、综合判别改善（IDI）和连续版净重新分类改善（NRI）来量化将炎症标志物添加到参考模型中的增量价值。P<0.05被认为具有统计学意义。
参考PHLF模型在当前队列中显示出可接受的预测性能，AUC为0.7492（95%CI，0.7191 - 0.7794）。与降钙素原（PCT）相关的计算ΔAUC是唯一具有统计学意义（P<0.05）的，值为0.0044，并且显示出AUC增加幅度最大。与全身免疫炎症指数（SII）相关的连续NRI值为35.79%，仅次于GPS（46.07%）。然而，具有统计学意义IDI的新模型的炎症标志物仅包括白细胞计数、淋巴细胞计数和SII。同时，与SII相关的IDI最大（0.0076），这与使用ΔAUC（0.0044）评估每个炎症变量的增量价值的表现一致。
在众多炎症标志物中，只有PCT和SII对预测可根治性切除HCC患者的PHLF具有潜在的增量预后价值。
