The Impact of the Monocyte-to-High-Density Lipoprotein Cholesterol Ratio on the Prognosis of Patients with Non-Viral,Non-Alcoholic Hepatocellular Carcinoma:a Retrospective Cohort Study
Background The incidence of primary non-viral hepatocellular carcinoma(NBNC-HCC)continues to increase,and abnormal lipid metabolism accompanied by inflammation is one of the main causes of NBNC-HCC,so the detection and evaluation of inflammatory markers may be an important method to predict the prognosis of NBNC-HCC.Objective To investigate the prognostic value of monocyte/high-density lipoprotein ratio(MHR)as a predictor in patients with NBNC-HCC.Methods A total of 119 patients diagnosed with NBNC-HCC at the Third Hospital of Hebei Medical University between January 2013 and February 2020 were enrolled.General information and laboratory test results were collected.Patients were divided into four groups based on the quartiles of their MHR values:Q1(MHR<0.33,n=28),Q2(0.33≤MHR<0.66,n=31),Q3(0.66≤MHR<1.59,n=30),and Q4(MHR≥1.59,n=30).Patients were followed up regularly,and data on their survival status and time of death were recorded.The primary endpoint was the overall survival(OS)of patients with NBNC-HCC.Restricted cubic splines(RCS)were plotted to assess the correlation between MHR at admission and patient mortality.Receiver operating characteristic(ROC)curves were plotted to analyze the value of MHR at admission in predicting 36-month survival of patients with NBNC-HCC.Cox proportional hazards models and BP neural network models were used to analyze the independent risk factors for patients with NBNC-HCC.The Kaplan-Meier method was used to plot survival curves for the prognosis of patients with NBNC-HCC,and the Log-rank test was performed.Results There were statistically significant differences in diabetes,proportion of surgeries,Barcelona Clinic Liver Cancer(BCLC)stage,aspartate aminotransferase(AST),C-reactive protein(CRP),gamma-glutamyltransferase(γ-GT),cholinesterase(CHE),urea(UREA),creatinine(Scr),high-density lipoprotein cholesterol(HDL-C),white blood cell count(WBC),red blood cell count(RBC),monocyte count(MONO),neutrophil count(NEUT),and albumin-bilirubin(ALBI)score among the Q1 to Q4 groups(P<0.05).ROC curves were plotted for MHR,MONO,and HDL-C to predict the prognosis of patients with NBNC-HCC.The results showed that MHR(AUC=0.822,95%CI=0.742-0.903,P<0.05)had a better predictive effect on patient prognosis than MONO(AUC=0.723,95%CI=0.618-0.828)(Z=4.34,P<0.05)and HDL-C(AUC=0.216,95%CI=0.119-0.313)(Z=2.088,P<0.05).Multivariate Cox regression analysis showed that BCLC stage B-D,CRP,and MHR were independent risk factors for all-cause mortality in patients with NBNC-HCC(P<0.05).After adjusting for hypertension,smoking,alcohol consumption,diabetes,alanine aminotransferase(ALT),and AST,Q2(OR=1.926,95%CI=1.005-3.689,P=0.015),Q3(OR=3.418,95%CI=1.774-6.586,P<0.05),and Q4(OR=7.677,95%CI=3.773-15.621,P<0.05)were risk factors for patient mortality.RCS results showed a non-linear dose-response relationship between MHR at admission and the risk of mortality in patients with NBNC-HCC(Ptrend<0.001,Pnon-linearity<0.001).When MHR at admission was>0.67,the hazard ratio(HR)was>1,indicating that MHR at admission was a risk factor for mortality in patients with NBNC-HCC(P<0.05).BP neural network model analysis found that the main factors affecting the prognosis of patients with NBNC-HCC included BCLC stage(100.0%),vascular invasion(76.3%),extrahepatic metastasis(40.6%),MHR(39.3%),CRP(38.7%),ALBI score(35.5%),total bilirubin(35.0%),MONO(34.8%),and NEUT(29.8%).There was a statistically significant difference in the cumulative survival rates among the Q1 to Q4 groups(χ2=61.86,P<0.001).Conclusion MHR was related to the prognosis of NBNC-HCC patients with a good predictive value.
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