Prognostic effect of systemic inflammation in patients undergoing surgery for hepatocellular carcinoma: comparison of composite ratios and cumulative scores

BACKGROUND: The systemic inflammatory has been suggested to predict the prognosis of cancer patients. There are two kinds of methods for evaluating the systemic inflammatory response, namely, composite ratios and cumulative scores. The aim of our study was to compare the prognostic effect of scores and ratios in patients undergoing surgery for liver cancer. METHODS: We retrospectively enrolled patients who underwent curative resection for hepatocellular carcinoma (HCC) performed between January 2015 to December 2017 in Fudan University Shanghai Cancer Center (FUSCC). Preoperative lymphocyte, monocyte, neutrophil and platelet counts, and CRP and albumin of liver cancer patients were recorded. The relationships among composite ratios, including the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), and C-reactive protein albumin ratio (CAR); cumulative scores, including the neutrophil-lymphocyte score (NLS), platelet-lymphocyte score (PLS), neutrophil-platelet score (NPS), and modified Glasgow prognostic score (mGPS); clinicopathological characteristics; and overall survival (OS) were explored. RESULTS: A total of 595 patients were enrolled. When multivariate analysis was adjusted according to TNM, PLR >150, LMR >2.4, CAR >0.22, NLS =1, PLS =1, NPS =1, and mGPS =1 were significantly associated with postoperative OS, except for NLR. CONCLUSIONS: Both cumulative scores and composite ratios had prognostic effect independent of TNM stage, in patients with liver cancer. However, cumulative scores, basing on normal reference ranges, are simpler and more stable for clinical use.