Division of Experimental Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London (UK); Division of Internal Medicine, Universitá degli Studi del Piemonte Orientale, Department of Clinical and Experimental Medicine, Novara (Italy).
Outcome prediction is uniquely different in hepatocellular carcinoma (HCC) as the progressive functional impairment of the liver impacts patient survival independently from tumour stage. As chronic inflammation is associated with the pathogenesis of HCC, we explored the prognostic impact of a panel of inflammatory based scores, including the modified Glasgow Prognostic Score (mGPS), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR), in independent cohorts.
Inflammatory markers, Barcelona Clinic Liver Cancer (BCLC) and Cancer of the Liver Italian Program (CLIP) scores were studied in a training set of 112 patients with predominantly unresectable HCC (75%). Independent predictors of survival identified on multivariate analysis were validated in an independent cohort of 466 patients with an overall lower tumour burden (BCLC-A, 56%).
In both the training and validation sets, the mGPS and CLIP scores emerged as independent predictors of overall survival. The predictive accuracy of the combined mGPS and CLIP score (c score 0.7, 95% CI 0.6 - 0.8) appeared superior to that of the CLIP score alone (c score 0.6, 95% CI 0.5 - 0.7).
Systemic inflammation as measured by the mGPS independently predicts overall survival in HCC. We have validated a novel, easy to use inflammatory score that can be used to stratify individuals. These data enable formulation of a new prognostic system, the Inflammation Based Index in HCC (IBI). Further validation of the IBI considering treatment allocation and survival is warranted in an independent patient cohort.