Immune Cell Infiltration Scores Predict the Prognosis in Patients with Hepatocellular Carcinoma

Abstract

Background: Immune cell infiltration plays an important role in the occurrence, development, and prognosis of cancer. The purpose of this investigation was to explore the relationship between immunoscore and prognosis, and to build a clinical nomogram for predicting survival in hepatocellular carcinoma (HCC) patients. Patients and Methods: A total of 368 subjects were gathered in this study from the Cancer Genome Atlas, and the immunoscore was determined using the ESTIMATE (Estimation of STromal and Immune cells in MAlignant Tumor tissues using Expression data) model. To identify prognostic factors, a Cox proportional hazards regression model was used, and multivariate analysis was used to develop the nomogram. The predictive accuracy and discriminating ability of model were verified using concordance indices (C-indices), calibration, Kaplan-Meier analysis and receiver operating characteristic (ROC). Results: We divided the patients into three subgroups based on their immunoscore: low, medium, and high. A higher immunoscore was associated with significantly better overall survival (OS) and disease-free survival (DFS) than one with a lower immunoscore (hazard ratios (HR) with 95% confidence intervals (CI): 0.50 (0.27–0.92) and 0.39 (0.19–0.82)). Prediction using C-indices for OS was 0.66 (95% CI: 0.61–0.72) and for DFS was 0.74 (95% CI: 0.68–0.80). Nomogram predictions and actual observations showed a significant degree of agreement by ROC and calibration curve for OS and DFS probabilities at 3 and 5 years. Conclusions: HCC patients with high immunoscore have significantly improved OS and DFS. The immunoscore can be considered as a prognostic marker in HCC patients. Moreover, our nomograms may help establish a greater degree of accuracy in predicting prognosis.