A Systemic Inflammation Response Index (SIRI)-Based Nomogram for Predicting the Recurrence of Early Stage Hepatocellular Carcinoma After Radiofrequency Ablation

Abstract

To explore the prognostic value of the systemic inflammation response index (SIRI) defined as neutrophil count\u2009×\u2009monocyte count/lymphocyte count in the patients with early stage hepatocellular carcinoma (HCC) within the Milan criteria after radiofrequency ablation (RFA). The prognostic value of SIRI was evaluated in a primary cohort (n\u2009=\u2009403) and then further validated in an independent test cohort (n\u2009=\u2009140). A novel preoperative prognostic nomogram was constructed from a multivariate analysis and validated in an external validation cohort. The optimal cutoff value of SIRI for patient stratification into a low SIRI group and a high SIRI group was 1.36. Survival analysis showed that the median overall survival (OS) and recurrence-free survival (RFS) were significantly higher in patients with a low SIRI compared to those with a high SIRI. The alpha-fetoprotein (AFP), SIRI, tumor number and size were independent predictors of RFS based on multivariate analysis. The nomogram including the SIRI, tumor number, tumor size, AFP could more accurately determine the prognosis of HCC patients than BCLC stage (0.74 vs. 0.62, P\u2009<\u20090.001). In addition, the dynamic changes in post-RFA SIRI also had prognostic significance and patients with a reduction in the SIRI by\u2009>\u200975% had a better prognosis. Preoperative SIRI was an independent predictor for RFS in patients with early stage HCC within the Milan criteria. The comprehensive nomogram can objectively and reliably help clinicians identify high-risk patients and develop individualized treatment plans.