Inflammation Markers and HCC Aggressiveness

Inflammation is thought to be important in the development and progression of Hepatocellular Carcinoma (HCC), but which inflammatory indices are more useful in clinical practice is not clear.

Several inflammatory indices were examined with respect to Maximum Tumor Diameter (MTD), Portal Vein Thrombosis by Tumor (PVT) and survival.

Serum C-Reactive Protein (CRP) and Platelet Lymphocyte Ratio (PLR) each significantly increased with increasing MTD as did percent patients with higher Glasgow index; whereas albumin levels and HALP (Hemoglobin, Albumin, Lymphocytes and Platelets) score decreased, as expected. Lower (abnormal) albumin was associated with higher alpha-fetoprotein and percentage PVT patients. Cox proportional hazard models for death showed a significant protective effect for albumin, whereas CRP and the Glasgow score had significant Hazard Ratios (HR) for death, but neither PLR nor the HALP score had significant HRs. Kaplan-Meier analysis showed reduced survival at each MTD for patients with low versus high albumin levels. All parameters were significantly different for presence versus absence of PVT, but only albumin and CRP had significance in Cox proportional hazard models for death in patients with PVT and only albumin for patients with high alpha-fetoprotein.

Each inflammation parameter worsened with increase in MTD, but only albumin and CRP (and the Glasgow index) were significant for survival in the total cohort. Only serum albumin had significance for survival in patients with PVT or high alpha-fetoprotein.