Prognostic value of preoperative systemic immune-inflammation index/albumin for patients with hepatocellular carcinoma undergoing curative resection

Table 1 Patient demographics and baseline characteristics, n (%)

Characteristics	Total (n = 1653)
Sex
Female	247 (15)
Male	1406 (85)
Age, years
≤ 60	1185 (72)
> 60	468 (28)
Hepatitis B surface antigen
Negative	263 (16)
Positive	1390 (84)
Alpha-fetoprotein, ng/mL
< 400	1370 (83)
≥ 400	283 (17)
Platelets, 109/L
> 100	1,178 (71)
≤ 100	475 (29)
Neutrophil, 109/L
≤ 6.3	1577 (95)
> 6.3	76 (5)
Lymphocyte, 109/L
> 0.8	1547 (94)
≤ 0.8	106 (6)
Alanine transaminase, U/L
≤ 40	1199 (73)
> 40	454 (27)
Aspartate transaminase, U/L
≤ 40	966 (58)
> 40	687 (42)
Prothrombin time, second
≤ 13	1360 (82)
> 13	293 (18)
Total bilirubin, μmol/L
≤ 32.4	1630 (99)
> 32.4	23 (1)
Albumin, g/L
> 35	1572 (95)
≤ 35	81 (5)
Albumin-bilirubin grade
1	1279 (77)
2	374 (23)
Tumor diameter, cm
< 5	785 (47)
≥ 5	868 (53)
Number of tumors
Single	1389 (84)
Multiple	264 (16)
Barcelona Clinic Liver Cancer stage
0	152 (9)
A	1192 (72)
B	184 (11)
C	125 (8)
Hypertension
No	1397 (85)
Yes	256 (15)
Diabetes
No	1518 (92)
Yes	135 (8)
Cardiovascular disease
No	1624 (98)
Yes	29 (2)
Anatomical resection
No	1068 (65)
Yes	585 (35)
Major hepatectomy
No	1415 (86)
Yes	238 (14)
Transfusion
No	1557 (94)
Yes	96 (6)
Differentiation
I-II	898 (54)
III-IV	755 (46)
Microvascular invasion
No	1177 (71)
Yes	476 (29)
Cirrhosis
No	795 (48)
Yes	858 (52)
Portal vein tumor thrombus
No	1528 (92)
Yes	125 (8)
Systemic immune-inflammation index/albumin	6 (4, 10)
Systemic immune-inflammation index	271 (170, 447)
Neutrophil-to-lymphocyte ratio	2.10 (1.58, 2.93)
Platelet-to-lymphocyte ratio	88 (63, 125)

Median (interquartile range) for continuous variables.

Table 2 Association between systemic immune-inflammation index/albumin and clinicopathological characteristics, n (%)

Characteristics	Systemic immune-inflammation index/albumin		P value
	Low (n = 1142)	High (n = 511)
Sex			0.424
Female	176 (15.4)	71 (13.9)
Male	966 (84.6)	440 (86.1)
Age, years			0.503
≤ 60	813 (71.2)	372 (72.8)
> 60	329 (28.8)	139 (27.2)
Hepatitis B surface antigen			< 0.001
Negative	151 (13.2)	112 (21.9)
Positive	991 (86.8)	399 (78.1)
Alpha-fetoprotein, ng/mL			0.945
< 400	946 (82.8)	424 (83.0)
≥ 400	196 (17.2)	87 (17.0)
Platelets, 109/L			< 0.001
> 100	684 (59.9)	494 (96.7)
≤ 100	458 (40.1)	17 (3.3)
Neutrophil, 109/L			< 0.001
≤ 6.3	1135 (99.4)	442 (86.5)
> 6.3	7 (0.6)	69 (13.5)
Lymphocyte, 109/L			0.358
> 0.8	69 (6.0)	37 (7.2)
≤ 0.8	1073 (94.0)	474 (92.8)
Alanine transaminase, U/L			0.579
≤ 40	833 (72.9)	366 (71.6)
> 40	309 (27.1)	145 (28.4)
Aspartate transaminase, U/L			< 0.001
≤ 40	718 (62.9)	248 (48.5)
> 40	424 (37.1)	263 (51.5)
Prothrombin time, second			0.022
≤ 13	956 (83.7)	404 (79.1)
> 13	186 (16.3)	107 (20.9)
Total bilirubin, μmol/L			0.686
≤ 32.4	1127 (98.7)	503 (98.4)
> 32.4	15 (1.3)	8 (1.6)
Albumin, g/L			< 0.001
> 35	1108 (97.0)	464 (90.8)
≤ 35	34 (3.0)	47 (9.2)
Albumin-bilirubin grade			< 0.001
1	937 (82.0)	342 (66.9)
2	205 (18.0)	169 (33.1)
Tumor diameter, cm			< 0.001
< 5	654 (57.3)	131 (25.6)
≥ 5	488 (42.7)	380 (74.4)
Number of tumors			0.353
Single	966 (84.6)	423 (82.8)
Multiple	176 (15.4)	88 (17.2)
Barcelona Clinic Liver Cancer stage			< 0.001
0	128 (11.2)	24 (4.7)
A	837 (73.3)	355 (69.5)
B	110 (9.6)	74 (14.5)
C	67 (5.9)	58 (11.4)
Hypertension			0.784
No	967 (84.7)	430 (84.1)
Yes	175 (15.3)	81 (15.9)
Diabetes			0.595
No	1046 (91.6)	472 (92.4)
Yes	96 (8.4)	39 (7.6)
Cardiovascular disease			0.409
No	1124 (98.4)	500 (97.8)
Yes	18 (1.6)	11 (2.2)
Anatomical resection			< 0.001
No	769 (67.3)	299 (58.5)
Yes	373 (32.7)	212 (41.5)
Major hepatectomy			< 0.001
No	1034 (90.5)	381 (74.6)
Yes	108 (9.5)	130 (25.4)
Transfusion			< 0.001
No	1099 (96.2)	458 (89.6)
Yes	43 (3.8)	53 (10.4)
Differentiation			< 0.001
I-II	664 (58.1)	234 (45.8)
III-IV	478 (41.9)	277 (54.2)
Microvascular invasion			< 0.001
No	864 (75.7)	313 (61.3)
Yes	278 (24.3)	198 (38.7)
Cirrhosis			< 0.001
No	466 (40.8)	329 (64.4)
Yes	676 (59.2)	182 (35.6)
Portal vein tumor thrombus			< 0.001
No	1075 (94.1)	453 (88.6)
Yes	67 (5.9)	58 (11.4)

Table 3 Univariate and multivariate Cox proportional hazards regression models for overall survival and recurrence-free survival

Variables	Overall survival				Recurrence-free survival
	Univariate		Multivariate		Univariate		Multivariate
	HR (95%CI)	P value	AHR (95%CI)	P value	HR (95%CI)	P value	AHR (95%CI)	P value
Sex
Female	Reference				Reference
Male	1.19 (0.95-1.50)	0.134			1.18 (0.97-1.42)	0.09
Age, years
≤ 60	Reference		Reference		Reference		Reference
> 60	0.70 (0.58-0.84)	< 0.001	0.79 (0.65-0.96)	0.017	0.73 (0.63-0.85)	< 0.001	0.77 (0.66-0.90)	0.001
Hepatitis B surface antigen
Negative	Reference		Reference		Reference		Reference
Positive	1.58 (1.24-2.01)	< 0.001	1.38 (1.07-1.79)	0.014	1.44 (1.19-1.75)	< 0.001	1.31 (1.07-1.61)	0.009
Alpha-fetoprotein, ng/mL
< 400	Reference		Reference		Reference		Reference
≥ 400	1.58 (1.32-1.91)	< 0.001	1.26 (1.04-1.52)	0.018	1.38 (1.18-1.63)	< 0.001	1.21 (1.02-1.43)	0.027
Alanine transaminase, IU/L
≤ 40	Reference		Reference		Reference		Reference
> 40	1.48 (1.26-1.75)	< 0.001	0.96 (0.79-1.17)	0.69	1.40 (1.21-1.60)	< 0.001	0.92 (0.78-1.08)	0.315
Aspartate transaminase, IU/L
≤ 40	Reference		Reference		Reference		Reference
> 40	2.19 (1.87-2.57)	< 0.001	1.31 (1.07-1.60)	0.007	2.08 (1.83-2.37)	< 0.001	1.47 (1.25-1.74)	< 0.001
Prothrombin time, second
≤ 13	Reference		Reference		Reference		Reference
> 13	1.41 (1.16-1.70)	< 0.001	1.18 (0.97-1.43)	0.073	1.25 (1.06-1.47)	0.007	1.08 (0.92-1.28)	0.352
Total bilirubin, μmol/L
≤ 32.4	Reference				Reference
> 32.4	1.00 (0.52-1.92)	0.992			1.02 (0.59-1.76)	0.953
Albumin-bilirubin grade
1	Reference		Reference		Reference		Reference
2	1.79 (1.51-2.12)	< 0.001	1.28 (1.07-1.60)	0.007	1.45 (1.25-1.68)	< 0.001	1.08 (0.93-1.27)	0.316
Tumor diameter, cm
< 5	Reference		Reference		Reference		Reference
≥ 5	3.13 (2.63-3.73)	< 0.001	2.12 (1.74-2.58)	< 0.001	2.48 (2.17-2.85)	< 0.001	1.85 (1.59-2.15)	< 0.001
Number of tumors
Single	Reference		Reference		Reference		Reference
Multiple	1.65 (1.37-1.99)	< 0.001	1.55 (1.27-1.87)	< 0.001	1.87 (1.60-2.19)	< 0.001	1.76 (1.50-2.07)	< 0.001
Hypertension
No	Reference		Reference		Reference		Reference
Yes	0.74 (0.58-0.94)	0.013	1.01 (0.79-1.30)	0.933	0.82 (0.68-0.98)	0.034	1.02 (0.84-1.24)	0.842
Diabetes
No	Reference				Reference
Yes	1.04 (0.78-1.38)	0.792			0.84 (0.65-1.09)	0.191
Cardiovascular disease
No	Reference				Reference
Yes	0.76 (0.39-1.47)	0.413			0.68 (0.38-1.20)	0.18
Anatomical resection
No	Reference		Reference		Reference
Yes	1.21 (1.03-1.41)	0.022	0.96 (0.82-1.14)	0.668	1.10 (0.96-1.26)	0.161
Major hepatectomy
No	Reference		Reference		Reference		Reference
Yes	2.13 (1.76-2.58)	< 0.001	1.23 (1.01-1.51)	0.044	1.86 (1.57-2.20)	< 0.001	1.13 (0.95-1.35)	0.172
Transfusion
No	Reference		Reference		Reference		Reference
Yes	1.98 (1.50-2.61)	< 0.001	1.00 (0.76-1.37)	0.987	1.61 (1.24-2.08)	< 0.001	0.90 (0.69-1.18)	0.455
Differentiation
I-II	Reference		Reference		Reference		Reference
III-IV	2.00 (1.71-2.34)	< 0.001	1.49 (1.27-1.76)	< 0.001	1.59 (1.40-1.81)	< 0.001	1.27 (1.11-1.45)	< 0.001
Microvascular invasion
No	Reference		Reference		Reference		Reference
Yes	2.52 (2.15-2.95)	< 0.001	1.59 (1.34-1.89)	< 0.001	2.21 (1.93-2.53)	< 0.001	1.56 (1.35-1.80)	< 0.001
Cirrhosis
No	Reference				Reference
Yes	1.02 (0.87-1.19)	0.825			1.03 (0.90-1.17)	0.667
Portal vein tumor thrombus
No	Reference		Reference		Reference		Reference
Yes	4.08 (3.28-5.07)	< 0.001	2.18 (1.73-2.74)	< 0.001	3.20 (2.60-3.95)	< 0.001	1.91 (1.53-2.38)	< 0.001
Systemic immune-inflammation index/albumin
Low	Reference		Reference		Reference		Reference
High	1.93 (1.64-2.26)	< 0.001	1.22 (1.03-1.46)	0.025	1.63 (1.42-1.87)	< 0.001	1.19 (1.03-1.38)	0.022

HR: Hazard ratio; AHR: Adjusted hazard ratio.