术前中性粒细胞/淋巴细胞比值对肝细胞癌患者预后评估的相关分析

Correlation analysis of preoperative neutrophil-to-lymphocyte ratio in evaluating prognosis of patients with hepatocellular carcinoma after curative hepatectomy

目的探讨术前中性粒细胞/淋巴细胞比值(NLR)对根治性切除术后肝细胞癌患者预后的评估价值。方法回顾性分析中国科学技术大学附属第一医院326例行肝癌根治性切除的患者的病例资料,根据患者术前1周内外周血NLR大小分为低NLR组(NLR <2. 560)和高NLR组(NLR≥2. 560)。应用Kaplan-Meier方法分析患者的生存率,并采用Log-rank检验差异,利用Cox回归模型分析影响预后的风险因素。结果低NLR组和高NLR组的1、3、5年无瘤生存率分别为81. 8%、66. 1%、42. 6%和62. 6%、35. 7%、25. 4%,1、3、5年总生存率分别为90. 7%、81. 3%、61. 2%和83. 5%、72. 6%、46. 9%。两组的无瘤生存率和总生存率进行比较,差异具有统计学意义(X2=6. 973,19. 750; P <0. 05)。单因素分析显示,术前AFP≥400ug/L,肿瘤直径≥5cm,肿瘤数目≥2个,血管侵犯,巴塞罗那分期B或C期,ALT≥80u/L,NLR≥2. 560是影响HCC患者术后无瘤生存期和总生存期的危险因素(P <0. 05); Cox多因素分析显示,术前NLR≥2. 560是影响HCC患者术后无瘤生存期(P <0. 05)与总生存期(P <0. 05)的独立危险因素。结论术前NLR可作为HCC患者根治性切除术后评估预后的指标,术前NLR较高者则预后较差。

Objective To investigate the value of preoperative neutrophil-to-lymphocyte ratio (NLR)in evaluating the prognosis of patients with hepatocellular carcinoma after curative hepateetomy.Methods A retrospective analysis of 326 patients with radical resection of hepatoeellular carcinoma in the First Affiliated Hospital of University of Science and Technology of China was divided into low NLR group (NLR <2.560)and high NLR group (NLR≥2.560)according to the peripheral blood NLR within 1 week before surgery.The Kaplan-Meier method was used to analyze the survival rate of patients,the difference was checked by Log-rank test,and the risk factors affecting prognosis were analyzed by Cox regression model.Results The l,3,and 5-year disease-free survival rates of the low NLR group and the high NLR group were 81.8%,66.1%,42.6%,and 62.6%,35.7%,25.4%,and the 1,3,and 5-year overall survival rates were 90.7%,81.3%,61.2%,and 83.5%,72.6%,46.9%,respectively.There were significant differences between two groups in overall survival rates and disease-free survival rates (x^2 =6.973,19.750;P <0.05 ).Univariate analysis showed that preoperative AFP ≥400ug/L,tumor size t>5cm,muhiple tumors ≥2,vascular invasion,Barcelona stage B or C,ALT ≥80u/L,NLR ≥2.560 were all risk factors of poor disease-free survival and overall survival(P <0.05);Cox multivariate analysis showed that preoperative NLR≥2.560 was an independent risk factor of disease-free survival (P <0.05 )and overall survival (P < 0.05 )after radical resection of HCC.Conclusions Preoperative NLR can be used as a prognostic indicator for patients with HCC after radical resection,and the prognosis of patients with high Preoperative NLR is poor.