肝动脉介入灌注化疗/栓塞术前中性粒细胞与淋巴细胞比值对原发性肝癌患者预后的影响

Impact of preoperative peripheral blood neutrophil-to-lymphocyte ratio on prognosis of liver cancer patients undergoing transcatheter arterial chemoembolization

目的:探讨原发性肝癌(PHC)患者术前中性粒细胞/淋巴细胞比值(NLR)对预后的影响。方法:回顾性分析96例行经导管肝动脉栓塞化疗(TACE)术的PHC患者临床病理资料。根据术前NLR值,分为低NLR组(NLR<2.5)和高NLR组(NLR≥2.5),分析两组患者总生存时间与无进展生存时间;并对其影响预后的危险因素行单因素与多因素分析。结果:全组介入术后,中位总生存时间21.1个月;其中术前高NLR组中位总生存时间16.0个月;术前低NLR组中位总生存时间23.3个月;两组中位生存时间差异有统计学意义(P=0.002)。全组患者中位无进展生存时间13.8个月,其中高NLR组中位无进展生存时间9.6个月,低NLR组中位无进展生存时间17.6个月,两组中位无进展生存时间差异有统计学意义(P=0.011)。单因素分析显示:肝功能Child分级、BCLC分期、AFP、假包膜形成、血供、TACE次数、NLR≥2.5是影响PHC患者TACE术后总生存时间的危险因素(P<0.05)。肝功能Child分级、BCLC分期、假包膜形成、血供、NLR≥2.5是影响PHC患者TACE术后无进展生存时间的危险因素(P<0.05);多因素分析显示,肝功能Child分级、BCLC分期、NLR≥2.5是影响PHC患者TACE术后生存的独立预后因素(P<0.05)。BCLC分期、NLR≥2.5是影响PHC患者TACE术后无进展生存时间的独立预后因素(P<0.05)。结论:术前外周血NLR可作为PHC患者行TACE的预后指标,NLR高者预后差。

Objective：To investigate the impact of the preoperative peripheral blood neutrophil - to - lymphocyte ratio（NLR）on postoperative prognosis of patients with primary hepatic cancer（PHC）. Methods：Clinicopathologic data of 96 PHC patients undergoing transcatheter arterial chemoembolization（TACE）were analyzed retrospectively. Based on the preoperative neutrophil - to - lymphocyte ratio（NLR）,the patients were divided into low NLR group （NLR 〈 2. 5）and high NLR（NLR≥2. 5）group. The overall survival time and progress - free survival time of the two groups were analyzed,and risk factors that would influence the prognosis of these patients were determined by uni-variate and multivariate analyses. Results：The median overall survival time for the entire group was 21. 1 months, which for high NLR group and low NLR group was 16. 0 and 23. 3 respectively. The difference in the overall survival between the two groups had statistical significance（P = 0. 002）. The median progress free survival time for the entire group was 13. 8 months,which for high NLR group and low NLR group was 9. 6 and 17. 6,and there was statistically significant difference in the progression - free survival time between the two groups（P = 0. 011）. Univariate analysis showed that liver function Child classification,BCLC staging,AFP,formation of psuedocapsule,blood supply,frequen-cy of TACE and NLR≥2. 5 were the risk factors for the postoperative overall survival time of PHC patients undergoing TACE（P 〈 0. 05）,and liver function Child classification,BCLC staging,formation of psuedocapsule,blood supply and NLR≥2. 5 were the risk factors for the postoperative progress - free time of PHC patients undergoing TACE（P 〈0. 05）. Multivariate analysis revealed that liver function Child classification,BCLC staging and NLR≥2. 5 were the independent prognostic factors for the survival of PHC patients undergoing TACE（all P 〈 0. 05）,and BCLC staging and NLR≥2. 5 were the independent prognostic factors for postoperative progress - free time of PHC patients under-going TACE（P 〈 0. 05）. Conclusion：Preoperative peripheral blood NLR can be used as a prognostic predictor of PHC patients undergoing TACE,and those with high NLR face a poor prognosis.