Prognostic impact of lactic dehydrogenase to albumin ratio in hepatocellular carcinoma patients with Child–Pugh I who underwent curative resection: a prognostic nomogram study

Abstract

Wei Gan,1 Mei-Xia Zhang,1,2 Jia-Xing Wang,3 Yi-Peng Fu,1 Jin-Long Huang,1 Yong Yi,1 Chu-Yu Jing,1 Jia Fan,1 Jian Zhou,1 Shuang-Jian Qiu1,2 1Department of Liver Surgery and Liver Transplantation, Liver Cancer Institute, Zhongshan Hospital and Shanghai Medical School, Fudan University, Key Laboratory for Carcinogenesis and Cancer Invasion, The Chinese Ministry of Education, Shanghai, People’s Republic of China; 2Biomedical Research Center, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; 3Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China Background: Radical resection is the treatment of choice for hepatocellular carcinoma (HCC). However, even with this treatment, HCC prognosis and the efficacy of current predictive models for such patients remain unsatisfactory. Here, we describe an accurate and easy-to-use prognostic index for patients with HCC who have undergone curative resection.Methods: The study population comprised of 1,041 patients with HCC who underwent curative resection at Zhongshan Hospital. This population was reduced to 768 patients who were treated in 2012 analyzed as the training cohort and 273 patients treated in 2007 who were used as a validation cohort.Results: The lactic dehydrogenase to albumin ratio (LAR) was identified as a significant prognostic index for both overall survival and recurrence-free survival in two independent cohorts. The optimal cutoff value for LAR was determined to be 5.5. The C-index of LAR was superior to other inflammatory scores and serum parameters. This biomarker was also shown to be a stable predictive index in the validation cohort. The new nomogram combining LAR with the Barcelona Clinic Liver Cancer staging system had an improved ability to discriminate overall survival and recurrence-free survival. Nomogram predictions were consistent with observations based on calibration and decisive curve analysis in both independent cohorts.Conclusion: LAR is a novel, convenient, reliable, and accurate prognostic predictor in patients with HCC undergoing curative resection. Our results suggest the recommendation of LAR to be used in routine clinical practice. Keywords: hepatocellular carcinoma, lactic dehydrogenase, LAR, nomogram, survival

Keywords

• Hepatocellular carcinoma
• lactic dehydrogenase
• LAR
• nomogram
• survival