Comparison of the prognostic value of different inflammation-based scores in patients with hepatocellular carcinoma after Lenvatinib therapy

Table 1 Baseline characteristics of the enrolled patients

Variables	n = 144
Age, year	52 (21-75)
Gender (male/female)	126/18 (87.5/12.5)
Hepatitis (yes/no)	128/16 (88.9/11.1)
ALT, U/L, (>/≤ 50)	64/80 (44.4/55.6)
AST, U/L, (>/≤ 40)	117/27 (81.3/18.7)
ALB, g/L, (>/≤ 35)	125/19 (86.8/13.2)
TBIL, µmol/L, (>/≤ 17.1)	62/82 (43/57)
Largest tumor size, cm	11.65 (1.2-23.1)
Tumor number (> 1/1)	109/35 (75.7/24.3)
Macrovascular invasion (yes/no)	102/42 (70.8/29.2)
Lymph node metastasis (yes/no)	39/105 (27/73)
Metastasis (yes/no)	27/117 (18.7/81.3)
TNM stage (III-IV/II)	125/19 (86.8/13.2)
CRP, mg/L (> 7.9/≤ 7.9)	100/44 (69.4/30.6)
PLR (1/0)	19/125 (13.2/86.8)
NLR (1/0)	73/71 (50.7/49.3)
LCR (1/0)	110/34 (76.4/23.6)
LMR (1/0)	89/55 (61.8/38.2)
SII (1/0)	78/66 (54.2/45.8)
CAR (1/0)	101/43 (70.1/29.9)
PNI (1/0)	71/73 (49.3/50.7)

Values are presented as median (range) or n (%). ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALB: Albumin; TBIL: Total bilirubin; TNM: Tumor-node-metastasis; CRP: C-reactive protein; PLR: Platelet-to-lymphocyte ratio; NLR: Neutrophil-to-lymphocyte ratio; LCR: Lymphocyte-to-C-reactive protein ratio; LMR: Lymphocyte-to-monocyte ratio; SII: Systemic immune-inflammation index; CAR: C-reactive protein-to-albumin ratio; PNI: Prognostic nutritional index.

Table 2 Systemic inflammation-based prognostic scores

Variable	Score
C-reactive protein, mg/L
≤ 7.9	0
> 7.9	1
Platelet-to-lymphocyte ratio
Platelet count (× 109/L): Lymphocyte count (× 109/L) ≤ 269.51	0
Platelet count (× 109/L): Lymphocyte count (× 109/L) > 269.51	1
Neutrophil-to-lymphocyte ratio
Neutrophil count (× 109/L): Lymphocyte count (× 109/L) ≤ 3.28	0
Neutrophil count (× 109/L): Lymphocyte count (× 109/L) > 3.28	1
Lymphocyte-to-C-reactive protein ratio
104 × lymphocyte count (× 109/L): CRP (mg/L) > 2500	0
104 × lymphocyte count (× 109/L): CRP (mg/L) ≤ 2500	1
Lymphocyte-to-monocyte ratio
Lymphocyte count (× 109/L): Monocyte count (× 109/L) ≤ 2.41	0
Lymphocyte count (× 109/L): Monocyte count (× 109/L) > 2.41	1
Systemic immune-inflammation index
Platelet count (× 109/L) × neutrophil count (× 109/L)/Lymphocyte count (× 109/L) ≤ 768.03	0
Platelet count (× 109/L) × neutrophil count (× 109/L)/Lymphocyte count (× 109/L) > 768.03	1
C-reactive protein-to-albumin ratio
C-reactive protein (mg/L): Albumin (g/L) ≤ 0.19	0
C-reactive protein (mg/L): Albumin (g/L) > 0.19	1
Prognostic nutritional index
Albumin (g/L) + 5 × lymphocyte count (× 109/L) > 49.1	0
Albumin (g/L) + 5 × lymphocyte count (× 109/L) ≤ 49.1	1

CRP: C-reactive protein.

Table 3 Univariate and multivariate Cox regression analyses of risk factors for overall survival

Variables	Univariate			Multivariate
	HR	95%CI	P value	HR	95%CI	P value
Age, year (>/≤ 50)	0.821	0.325-2.075	0.677
Gender (female/male)	0.273	0.036-2.057	0.207
Largest tumor size, cm (>/≤ 10)	1.982	0.702-5.6	0.197
Tumor number (> 1/1)	8.086	1.073-60.944	0.043
Macrovascular invasion (yes/no)	10.399	1.380-78.368	0.023	10.594	1.394-80.525	0.023
Lymph node metastasis (yes/no)	1.383	0.490-3.908	0.540
Metastasis (yes/no)	4.393	1.47-13.128	0.008	4.431	1.395-14.073	0.012
PT, s (>/≤ 13.5)	1.098	0.251-4.799	0.901
HBsAg, IU/mL (>/≤ 0.05)	2.386	0.317-17.942	0.398
ALB, g/L (>/≤ 35)	1.322	0.382-4.569	0.659
ALT, U/L (>/≤ 50)	1.118	0.443-2.821	0.813
APOB, g/L (>/≤ 1.10)	0.822	0.308-2.196	0.697
APOA1, g/L (>/≤ 1.60)	1.166	0.267-5.094	0.838
AST, U/L (>/≤ 40)	27.327	0.145-5143.118	0.216
CHO, mmol/L (>/≤ 5.69)	1.038	0.402-2.683	0.938
CRE, µmol/L (>/≤ 97)	1.969	0.452-8.573	0.367
CRP, mg/L (>/≤ 7.9)	4.494	1.031-19.585	0.045
GGT, U/L (>/≤ 60)	27.116	0.115-6392.722	0.236
TBIL, µmol/L (>/≤ 20.5)	2.628	1.027-6.727	0.044
MO, × 109/L (>/≤ 0.6)	1.204	0.477-3.042	0.694
NE, × 109/L (>/≤ 6.3)	1.084	0.386-3.047	0.878
WBC, × 109/L (>/≤ 9.5)	1.067	0.351-3.246	0.909
PLR (>/≤ 269.51)	2.843	1.009-8.008	0.048
NLR (>/≤ 3.28)	3.268	1.161-9.195	0.025
LCR (>/≤ 3185.19)	7.315	0.971-55.084	0.053
LMR (>/≤ 2.41)	0.276	0.105-0.725	0.009
SII (>/≤ 768.03)	2.888	1.021-8.166	0.046
CAR (>/≤ 0.19)	2.708	0.782-9.374	0.116
PNI (>/≤ 49.1)	3.924	1.384-11.124	0.01	4.097	1.405-11.944	0.01

P < 0.05 is statistically significant in both univariate and multivariate analyses. PT: Prothrombin time; HBsAg: Hepatitis B surface antigen; ALB: Albumin; ALT: Alanine aminotransferase; APOB: Apolipoprotein B; APOA1: Apolipoprotein A1; AST: Aspartate aminotransferase; CHO: Cholesterol; CRE: Creatinine; CRP: C-reactive protein; GGT: Γ-Glutamyl transferase; TBIL: Total bilirubin; PLR: Platelet-to-lymphocyte ratio; NLR: Neutrophil-to-lymphocyte ratio; LCR: Lymphocyte-to-C-reactive protein ratio; LMR: Lymphocyte-to-monocyte ratio; SII: Systemic immune-inflammation index; CAR: C-reactive protein-to-albumin ratio; PNI: Prognostic nutritional index; MO: Monocyte; NE: Neutrophil; WBC: White blood cell.

Table 4 Baseline characteristics of patients grouped by prognostic nutritional index, n (%)

Variables	PNI ≤ 49.1 (n = 71)	PNI > 49.1 (n = 73)	P value
Age, year	54 (29-74)	50 (21-75)	0.018
Gender (male/female)	64/7 (90.1/9.9)	62/11 (84.9/15.1)	0.345
Hepatitis (yes/no)	58/13 (81.7/18.3)	54/19 (74.0/26.0)	0.265
ALT, U/L	48.1 (10-177.1)	42.9 (0.5-320.3)	0.248
AST, U/L	73.1 (27.1-506.7)	69.6 (21.8-290.5)	0.002
ALB, g/L	37.7 (28.3-46.4)	43.9 (35.2-50.9)	< 0.001
TBIL, µmol/L	17.2 (5.3-60.9)	15.8 (5.5-31.1)	0.068
Largest tumor size, cm	12.4 (2.8-23.1)	10.4 (1.2-21.5)	0.003
Tumor number (> 1/1)	59/12 (83.1/16.9)	50/23 (68.5/31.5)	0.041
Macrovascular invasion (yes/no)	56/15 (78.9/21.1)	46/27 (63.0/37.0)	0.036
Lymph node metastasis (yes/no)	18/53 (25.4/74.6)	21/52 (28.8/71.2)	0.645
TNM stage (III-IV/II)	64/7 (90.1/9.9)	61/12 (83.6/16.4)	0.243
Best tumor response
CR	0 (0)	0 (0)
PR	19 (26.8)	26 (35.6)
SD	34 (47.9)	33 (45.2)
PD	18 (25.4)	14 (19.2)
ORR	19 (26.8)	26 (35.6)	0.252
DCR	53 (74.6)	59 (80.8)	0.373

Values are presented as median (range). P < 0.05 is statistically significant. PNI: Prognostic nutritional index; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALB: Albumin; TBIL: Total bilirubin; TNM: Tumor-node-metastasis; CR: Complete response; PR: Partial response; SD: Stable disease; PD: Progressive disease; ORR: Objective response rate; DCR: Disease control rate.