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High Inflammatory Factor Grading Predicts Poor Disease-Free Survival in AJCC Stage I-II Hepatocellular Carcinoma Patients After R0 Resection

Authors Zhang M, Chua MS, Hu J, Li H, Zhang S, Wu L, Han B

Received 9 September 2019

Accepted for publication 26 November 2019

Published 19 December 2019 Volume 2019:11 Pages 10623—10632


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Sanjeev Srivastava

Mao Zhang,1 Mei-Sze Chua,2 Jie Hu,3 Haoran Li,1 Shun Zhang,1 Liqun Wu,1 Bing Han1

1Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People’s Republic of China; 2Asian Liver Center, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA; 3Department of General Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China

Correspondence: Bing Han; Liqun Wu
Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, Shandong 266003, People’s Republic of China
Tel +86-186 6180 8308
Fax +86-532-8291 1323

Purpose: In this study, we established the inflammatory factor grade system (IFGs) based on the hepatocellular carcinoma (HCC) microenvironment to investigate the role of inflammatory factor grade (IFG) in predicting the prognosis of patients with American Joint Committee on Cancer (AJCC) stage I-II.
Patients and methods: We enrolled 87 HCC patients with AJCC stage I-II who underwent R0 resection between 2000 and 2012 and had paraffin-embedded specimens. Immunohistochemistry (IHC) was performed to investigate the expression of 12 inflammatory factors and then to establish the IFGs (grade A or B) based on the IHC data. Subsequently, Kaplan-Meier and Cox univariate/multivariate survival analyses were performed to examine the potential prognostic significance.
Results: Higher IFG (IFG-B) is significantly associated with greater tumor size (P=0.037), and IFG-B predicts a worse disease-free survival (DFS, P<0.001). Moreover, a platelet count (PLT) ≤100×109/L, tumor size ≥5 cm, poor tumor differentiation, and IFG-B are independent risk factors for DFS.
Conclusion: Overall, by establishing a grading system for the level of inflammatory factors in the HCC microenvironment, IFG-B can effectively predict poor DFS in AJCC stage I-II HCC patients after R0 resection.

Keywords: hepatocellular carcinoma, recurrence, prognosis, inflammation

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