Su Yuhao, Liang Yuxin, Zhong Deyuan, Yan Hongtao, Yang Qinyan, Shang Jin, Chen Yahui, Huang Xiaolun
Department of Liver Transplantation Center and HBP Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
BMC Cancer. 2025 Mar 19;25(1):504. doi: 10.1186/s12885-025-13867-w.
Liver function, tumor burden, inflammation level, and nutritional status are critical factors influencing tumor onset, progression, and metastasis. This study sought to investigate the prognostic significance and clinical relevance of biomarkers associated with these factors to develop a novel liver function-tumor burden-inflammation-nutrition (LTIN) score for patients with hepatocellular carcinoma (HCC) who received hepatectomy.
A retrospective analysis was conducted on 285 patients with HCC undergoing hepatectomy at two medical centers between July 2019 and July 2023. The patients were divided into a training set (n = 200) and a validation set (n = 85). The study evaluated the prognostic significance of eight relevant clinical indicators and developed an LTIN score using Least Absolute Shrinkage and Selection Operator (LASSO) regression. Kaplan-Meier survival curves and multivariate Cox regression analysis were utilized to determine the prognostic value of the LTIN score. Time-dependent receiver operating characteristic (ROC) analyses were used to compare the predictive performance of various prognostic factors.
The LTIN score, derived from the albumin-bilirubin (ALBI) grade, tumor burden score (TBS), prognostic nutritional index (PNI), and prognostic inflammatory index (PII), effectively classified patients into high- and low-risk groups based on the optimal cut-off value. Patients with low-risk scores exhibited significantly better overall survival (OS) and recurrence-free survival (RFS) than those with high-risk groups in both the training and validation sets (P < 0.001). Furthermore, the LTIN score was identified as a significant independent prognostic factor for both OS (P < 0.001) and RFS (P < 0.001). The LTIN score also exhibited superior prognostic capabilities compared to the other indicators, Tumor-Node-Metastasis (TNM) staging system, and Barcelona Clinic Liver Cancer (BCLC) staging system.
Our findings indicated that the preoperative LTIN score has significant potential as a reliable predictor of OS and RFS for HCC patients underwent radical surgery. The LTIN score could further effectively guide treatment decisions and optimize follow-up strategies to enhance patients prognosis.
肝功能、肿瘤负荷、炎症水平和营养状况是影响肿瘤发生、进展和转移的关键因素。本研究旨在探讨与这些因素相关的生物标志物的预后意义和临床相关性，以开发一种针对接受肝切除术的肝细胞癌（HCC）患者的新型肝功能-肿瘤负荷-炎症-营养（LTIN）评分。
对2019年7月至2023年7月期间在两个医疗中心接受肝切除术的285例HCC患者进行回顾性分析。患者被分为训练集（n = 样本数）和验证集（n = 样本数）。本研究评估了八个相关临床指标的预后意义，并使用最小绝对收缩和选择算子（LASSO）回归开发了LTIN评分。采用Kaplan-Meier生存曲线和多因素Cox回归分析来确定LTIN评分的预后价值。采用时间依赖性受试者工作特征（ROC）分析来比较各种预后因素的预测性能。
基于白蛋白-胆红素（ALBI）分级、肿瘤负荷评分（TBS）、预后营养指数（PNI）和预后炎症指数（PII）得出的LTIN评分，根据最佳临界值有效地将患者分为高风险组和低风险组。在训练集和验证集中，低风险评分患者的总生存期（OS）和无复发生存期（RFS）均显著优于高风险组患者（P < 0.001）。此外，LTIN评分被确定为OS（P < 0.001）和RFS（P < 0.001）的显著独立预后因素。与其他指标、肿瘤-淋巴结-转移（TNM）分期系统和巴塞罗那临床肝癌（BCLC）分期系统相比，LTIN评分还表现出更好的预后能力。
我们的研究结果表明，术前LTIN评分作为接受根治性手术的HCC患者OS和RFS的可靠预测指标具有巨大潜力。LTIN评分可以进一步有效地指导治疗决策并优化随访策略，以改善患者的预后。
