Patient Demographics
We included a total of 250 HCC patients who underwent radical hepatectomy at the Third Affiliated Hospital of Sun Yat-sen University, including 225 men and 25 women. Of all patients, 221 patients were positive for hepatitis B surface antigen (HBsAg), and 29 patients were negative for HBsAg. There was only one lesion in 179 patients and multiple lesions in 71 patients. Based on the BCLC stage, there were 19, 79, 48, and 104 patients in stages 0, A, B, and C, respectively. The average age at diagnosis was 50 years. Detailed information is displayed in Table 1.
Correlation between the clinicopathologic features or hematologic parameters and coNLR-PDW
The correlation between coNLR-PDW and clinicopathological features or hematological parameters is shown In Table 2. Significant correlation were found in cirrhosis (P = 0.004), tumor size (P = 0.013), Child-Pugh grade (P = 0.041), GGT (P = 0.032), MPV (P < 0.001), PDW (P < 0.001)), NLR (P < 0.001), PLR (P = 0.004) and MLR (P = 0.001) among three coNLR-PDW groups. However, there were no statistical significance in age, gender, HBsAg, tumor number, alpha-fetoprotein (AFP), vascular invasion, BCLC stage, differentiation, PT, ALT, TB, and ALB.
Survival analysis of coNLR-PDW
OS and DFS curves for patients with whole resectable HCC were shown in Fig2. Kaplan-Meier analysis and log-rank test were adopted to identify the survival differences among the three groups stratified by the coNLR-PDW score. The OS curves of the three groups separate significantly, patients with coNLR-PDW scoring 2 has the worst survival compared with those with coNLR-PDW scoring 1 and 0. Similarly, the DFS curves classified by the coNLR-PDW score shows that DFS duration with coNLR-PDW scoring 0 is superior to that of co-NLR-PDW scoring 1, and coNLR-PDW scoring 1 is better than coNLR-PDW scoring 2 in DFS (Fig 3). Additionally, further analysis was performed in the subgroups of AFP (<400 ng/ml and ≥400 ng/ml) and BCLC stage (0-A and B-C). Higher score of coNLR-PDW predicted worse OS and DFS in the AFP subgroup (AFP<400 ng/ml: P < 0.0001 for OS, P < 0.0001 for DFS, Fig 4A and 4C; AFP ≥400 ng/ml: P = 0.0177 for OS, P =0.0003 for DFS, Fig 4B and 4D), and BCLC stage (BCLC 0-A: P = 0.0352 for OS, P < 0.0001 for DFS, Fig 5A and 5C; BCLC B-C: P = 0.0002 for OS, P = 0.0005 for DFS, Fig 5B and 5D).
Univariate and multivariate analyses for OS
According to univariate regression analyses, significant correlation was observed between tumor size (HR: 2.664, 95%CI: 1.424-4.983, P =0.002), AFP (HR: 2.310, 95%CI: 1.253-4.258, P =0.007), vascular invasion (HR: 2.327, 95%CI: 1.261-4.293, P=0.007), BCLC stage (HR: 2.543, 95%CI: 1.248-5.181, P =0.010), ALT (HR: 2.082, 95%CI: 1.046-4.146, P =0.037), GGT (HR: 3.825, 95%CI: 1.697-8.626, P =0.001) , PDW (HR: 3.384, 95%CI: 1.796-6.376, P <0.001), NLR (HR: 2.926, 95%CI: 1.149-7.450, P =0.024), PLR (HR: 2.585, 95%CI: 1.297-5.151, P =0.007), MLR (HR: 2.714, 95%CI: 1.472-5.002, P =0.001), coNLR-PDW (HR: 3.342, 95%CI: 1.960-5.699, P <0.001) and OS. Then these identified factors were selected for multivariate regression analysis, AFP (HR: 2.456, 95%CI: 1.317-4.581, P =0.005), GGT (HR: 3.957, 95%CI: 1.734-9.030, P =0.001), PLR (HR: 2.310, 95%CI: 1.146-4.658, P =0.019) and coNLR-PDW (HR: 3.674, 95%CI: 2.092-6.452, P <0.001) correlated with unfavorable OS significantly (Table 3).
Univariate and multivariate analyses for DFS
Tumor size (HR: 2.332, 95%CI: 1.650-3.296, P <0.001), Tumor number (HR: 2.198, 95%CI: 1.551-3.114, P <0.001), AFP (HR: 1.452, 95%CI: 1.010-2.087, P =0.044), vascular invasion (HR: 2.095, 95%CI: 1.485-2.955, P <0.001), BCLC stage (HR: 2.893, 95%CI: 1.932-4.332, P <0.001), GGT (HR: 2.084, 95%CI: 1.431-3.036, P<0.001), PDW (HR: 2.174, 95%CI: 1.542-3.064, P <0.001), NLR (HR: 2.445, 95%CI: 1.518-3.938, P <0.001), MLR (HR: 2.245, 95%CI: 1.594-3.163, P <0.001) and coNLR-PDW (HR: 2.292, 95%CI: 1.737-3.024, P <0.001) are significantly associated with DFS according to univariate regression analysis. Further multivariate regression analysis displays that tumor size (HR: 2.166, 95%CI: 1.523-3.082, P <0.001), tumor number (HR: 2.229, 95%CI: 1.569-3.166, P =0.013), MLR (HR: 1.800, 95%CI: 1.271-2.549, P =0.001), and coNLR-PDW (HR: 2.166, 95%CI: 1.523-3.082, P <0.001) are independent prognostic factors for DFS (Table 4).