Abstract
Abstract
Aims
We aimed to determine the value of the preoperative prognostic nutritional index (PNI) and establish new nomograms to predict recurrence-free and overall survival (RFS and OS) in elderly patients with early-stage hepatocellular carcinoma (HCC).
Methods
Elderly patients (≥ 60 years of age) with very early-stage HCC (CNLC IA-IIA) after curative surgical resection were identified. PNI was calculated by [10 × serum albumin level (gr/dL)] + [0.005 × total lymphocyte count (per mm3)]. Univariate and multivariate Cox analysis was used to screen the variables and construct the nomogram model. ROC and calibration curves were used for model evaluation.
Results
The PNI-high was defined as ≥ 49.5 and ≥ 49.05 for RFS and OS, respectively. The 5-year-RFS rate was 34.1% in the PNI-low group versus 57.4% in the PNI-high group (P = 0.014). The 5-year OS rate in the PNI-low group was significantly lower than that in the PNI-high groups (68.2% vs. 84.4%, P = 0.033). The nomogram prediction models for patients’ RFS and OS were built by incorporating the same three independent survival predictors, including PNI-low, tumor presence of vascular invasion, and low differentiation. These two prediction models demonstrated good calibration and discrimination, with all C‑indexes greater than 0.72. The calibration plots basically coincide with the diagonal, indicating that the observed RFS and OS were close to the predicted outcomes.
Conclusions
The PNI-low, tumor presence of vascular invasion, and low differentiation can be adopted as a decision aid to predict the long-term RFS and OS for elderly patients with resected HCC.
Publisher
Research Square Platform LLC
Reference31 articles.
1. Epigenetics in hepatocellular carcinoma;Nagaraju GP;Semin Cancer Biol,2022
2. Hepatocellular carcinoma;Forner A;Lancet,2018
3. Liver cancer stem cell markers: Progression and therapeutic implications;Sun JH;World J Gastroenterol,2016
4. Tumor-associated macrophages in liver cancer: From mechanisms to therapy;Cheng K;Cancer Commun (Lond),2022
5. Changing epidemiology of hepatocellular carcinoma in Asia;Zhang Ch;Liver International,2022