007), III-IV of TNM stage (HR, 1.727; 95% CI, 1.183-2.520; P = .005) and AST > 40 U/l (HR, 1.888; 95% CI, 1.391-2.563; P < .001) were independent predictors

for DFS ( Table 3). High NLR (HR, 1.639; 95% CI, 1.212-2.218; P = .001), size of tumor > 5 cm (HR, 1.922; 95% CI, 1.168-3.162; P = .010), III-IV of TNM stage (HR, 1.806; 95% CI, 1.236-2.638; P = .002), and AST > 40 U/l (HR, 1.916; 95% CI, 1.415-2.595; P < .001) were independent predictors for OS ( Table 3). We established a preoperative prognostic score model by calculating the number of independent predictors (NLR, size of tumor, TNM stage, and AST) for each patient. Each factor was allotted a score of 1, and then patients were divided into five categories by Antidiabetic Compound Library manufacturer their risk scores (RSs) (0, 1, 2, 3, find protocol and 4). For example, “RS = 0” means patients without any of the above factors; this group occupied 8.59% (22 of 256). “RS = 4” means patients with all four factors; it occupied 26.56% (68 of 256) of patients carrying all four factors (Figure 3). Because no significant difference were observed in DFS and OS between patients whose RS equals 0 or 1 (Figure 3, A

and C; P = .132 and P = .145, respectively), these patients were merged as score ≤ 1 group. By combining four independent predictors, patients with different RSs showed distinguishable DFS (RS ≤ 1 vs RS = 2, P < .001; RS = 2 vs RS = 3, P = .037; and RS = 3 vs RS = 4, P < .001) ( Figure 3B) and OS (RS ≤ 1 vs RS = 2, P < .001; RS = 2 vs RS = 3,

P = .015; and RS = 3 vs RS = 4, P < .001) ( Figure 3D). Surprisingly, the proportion of patients with HCC with RS = 4 was very high, occupying 26.56% (68 of 256) of total patients ( Figure 3A). The DFS and OS in 68 patients with a score of 4 decreased sharply, and all these patients showed much shorter DFS and OS. Experimental and clinical data indicate that chronic inflammation significantly contributes to cancer development. The presence of systemic inflammation is associated with poor survival in certain tumors [15]. Inflammation can promote all stages of tumor development through multiple mechanisms, else which include predisposing tumor cell to proliferation and resistance to apoptosis, induction of DNA mutations, and promotion of angiogenesis, invasion, and metastasis [19]. The prognostic value of some systemic inflammatory markers such as C-reactive protein [15] and NLR have been investigated in tumor patients. Inflammatory environments can accelerate the progression of metastasis by neutrophi- mediated mechanisms [20]. NLR reflects an inflammatory status; a preoperatively high ratio is most likely to reflect more aggressive disease and hence represents poorer outcome. Patients with tumor and elevated NLR have a relative lymphocytopenia and neutrophilic leukocytosis, which denote that the balance is tipped in favor of protumor inflammatory response leading to poor oncologic outcome.