凝血相关指标基于576例肝细胞癌患者预后中的预测价值研究

Prognostic Value of Coagulation Related Indexes Based on 576 Patients with Hepatocellular Carcinoma

[目的]探讨术前凝血指标在肝细胞癌患者预后预测中的价值。[方法]对2010—2019年于中国医学科学院北京协和医学院肿瘤医院就诊的肝癌患者进行回顾性分析,收集其临床资料和凝血相关等实验室检测信息。采用Cox回归方法进行单因素分析筛选出肝细胞癌患者预后相关指标。使用X-tile软件获得各检测指标最佳截断值。运用Kaplan-Meier法分析各风险组间的生存差异。通过倾向性评分匹配方法去除各组中混杂因素的影响。[结果]本次研究最终纳入576例肝细胞癌患者,中位随访时间为33.7个月(15.4~60.9个月)。Cox回归分析显示,术前凝血指标凝血酶原时间(PT)和纤维蛋白原(FIB)与肝细胞癌患者预后相关。PT和FIB最佳截断值分别为11.4 s和3.8 g/L。通过PT和FIB结果建立凝血评分系统,将肝细胞癌患者分为高风险组和低风险组,Kaplan-Meier分析显示两组间的生存差异有统计学意义(P<0.01);倾向性评分匹配将低风险组和高风险组采用1∶1比例匹配Cox回归分析中有差异的指标,匹配后Kaplan-Meier分析结果显示高风险组和低风险组间的生存差异有统计学意义(P<0.01)。凝血评分系统与甲胎蛋白(AFP)、谷丙转氨酶(ALT)、谷氨酰转肽酶(GGT)、乳酸脱氢酶(LDH)等指标分别联合评估,结果显示联合评估ROC曲线下面积(AUC值)均高于单个指标AUC值。[结论]PT和FIB联合形成的凝血评分系统对肝细胞癌患者预后有预测价值,为临床术前评估肝细胞癌患者预后提供参考数据。

[Objective]To investigate the prognostic value of coagulation indexes in patients with hepatocellular carcinoma(HCC).[Methods]Retrospective analysis was carried out on the patients with HCC who were treated in Chinese Academy of Medical Sciences and Peking Union Medical College from 2010 to 2019.The clinical data and laboratory testing information of HCC patients were collected.Cox proportional hazard regression analysis was applied to screen the prognostic factors for patients with HCC.The optimal cut-off values of test indexes were obtained by X-tile software.Kaplan-Meier method was used to plot survival curves for different groups,and Log-rank test was used to compare the significance.The propensity score-matched analysis was carried out to balance imbalanced variables.[Results]576 patients with hepatocellular carcinoma were finally included in this study.The median follow-up time was 33.7 months(15.4~60.9 months).Cox proportional hazards regression analysis showed that coagulation indexes of prothrombin time(PT)and fibrinogen(FIB)were related to the prognosis of patients with HCC.The best cut-off values of PT and FIB were 11.4 s and 3.8 g/L respectively.The coagulation scoring system was established based on the results of PT and FIB.The patients with hepatocellular carcinoma were divided into high risk group and low risk group.Kaplan-Meier analysis showed that there was significant difference in survival between the two groups(P<0.01).The propensity score matching will be used to match the different indicators in the Cox regression analysis of the low risk group and the high risk group with 1∶1 ratio.After matching,the Kaplan-Meier analysis results showed that there was also a significant difference in survival between the high risk group and the low risk group(P<0.01).The coagulation scoring system was evaluated jointly with AFP,ALT,GGT,LDH and other indicators,and the results showed that the AUC value of the combined evaluation was higher than that of the single indicator.[Conclusion]The coagulation evaluation system based on PT and FIB showed an important predictive value in this cohort of patients with HCC,which provided some evidence for the prognosis of preoperative HCC patients.