术后中性粒细胞/淋巴细胞比值变化对肝细胞肝癌切除术后患者预后的影响

Postoperative neutrophil to lymphocyte ratio predicts the prognosis of patients with hepatocellular carcinoma after curative hepatectomy

目的探讨术后外周血中性粒细胞/淋巴细胞比值(NLR)变化在预测肝细胞肝癌切除术后患者预后的价值。方法回顾性分析2007年1月至2009年12月在中山大学孙逸仙纪念医院肝胆外科根治性肝癌切除术155例患者的临床资料。根据患者术前1周内及术后1月外周血血常规结果计算NLR变化,将患者分为NLR升高组和NLR降低组。应用Kaplan-Meier方法分析生存曲线,Cox回归模型评估影响总体生存率的预后因素。结果 NLR降低组(108例)和NLR升高组(47例)的1、3、5年总体生存率分别为91.2%、80.4%、49.5%和80.2%、71.6%、42.5%(P<0.05)。肿瘤复发时间(TTR)中位数:NLR降低组为19.9月,升高组为15.2月(P<0.05)。Cox多因素分析显示术后NLR变化、肿瘤大小、肿瘤分期是影响总体生存率的独立预后因素。结论术后NLR变化是影响肝细胞肝癌切除术后患者预后的独立危险因素,术后NLR升高的患者预后差。

Objective To investigate the postoperative neutrophil to lymphocyte ratio （NLR） change in predicting the prognosis of patients after radical resection of hepatocellular carcinoma. Methods Clinical data of 155 patients with hepatocellular carcinoma （HCC） who underwent radical hepatectomy in Depart ment of Hepatobiliary Surgery, the Sun Yat-sen Memorial Hospital from January 2007 to December 2009 were analyzed retrospectively. NLR changes were calculated based on the routine examination results of peripheral blood within one week before and one month after surgery. Patients were divided into the NLR decreased group and the NLR increased group according to NLR change. Kaplan-Meier method was used to analyze survival curve and ~ox proportional hazard model was used to evaluate theprognostic factors of overall survival. Results The 5-year overall survival rates were 91.2%, 80.4%, 49.5% in NLR decreased group （108 cases） and 80.2%, 71.6%, 42.5% in NLR increased group （47 cases） （P〈0.05）. The median time to recurrence （TYR） was 19.9 months in NLR decreased group, and 15.2 months in NLR increased group（P〈0.05）. Cox multivariate analysis showed NLR change, tumor size, tumor stage were independent prognostic factors of overall survival. Conclusion The postoperative NLR change was an independent prognostic factor for HCC patient underwent radical hepatectomy, and patients with increased NLR indicated poor survival.