术前血小板/淋巴细胞比值与肝癌预后的关系

Relationship between platelet-to-lymphocyte ratio and prognosis in patients with hepatocellular carcinoma

目的：探讨术前血小板/淋巴细胞比值（PLR）与肝癌预后的关系。方法：回顾性分析行手术治疗的256例肝癌患者的临床资料。根据患者术前PLR水平,绘制PLR诊断肿瘤复发的受试者工作特征（ROC）曲线,确定PLR界值,分析术前外周血PLR水平分与患者临床病理因素及预后的关系。结果：PLR诊断肿瘤ROC曲线下面积为0.625（95%CI=0.544~0.706）,灵敏度为0.53,特异度为0.70,界值为131.81。患者术前外周血PLR水平与术前血清白蛋白、Child-Pugh分级、是否伴有腹水、血管侵犯、TNM分期等临床病理因素有关（均P〈0.05）。Cox风险模型分析显示,TNM分期（HR=1.441,95%CI=1.721~2.635,P〈0.001）、PLR（HR=1.737,95%CI=1.317~2.291,P〈0.001）为肝癌预后的独立影响因素,而PLR（HR=1.893,95%CI=1.434~2.497,P〈0.001）为肝癌复发的独立影响因素。生存分析显示,低PLR患者术后1、3、5年无瘤生存率（81.2%、53.3%、29.6%）明显高于PLR患者（62.4%、30.4%、11.6%）。结论：术前PLR可以作为肝癌患者的预后指标,高PLR水平患者术后复发率高、预后差。

Objective： To investigate the relationship between the prognosis ofhepatocellular carcinoma （HCC）. preoperative platelet-to-lymphocyte ratio （PLR） and Methods： The clinical data of 256 HCC patients undergoing surgical treatment were retrospectively analyzed. According to the preoperative PLR level of the patients, the receiver operating characteristic （ROC） curve was drawn, the cut-offvalue was determined, and the relations of the preoperative PLR level with the clinicopathologic factors and prognosis of the patients were analyzed.Results： The area under the curve ofROC of PLR for diagnosis of tumor recurrence was 0.625 （95% CI=0.544- 0.706）, with a sensitivity of 0.53, specificity of 0.70, and cut-offvalue of 131.81. The preoperative PLR level was significantly associated with the clinicopathologic factors that included preoperative serum albumin level, Child-Pugh liver function classification, the presence or absence of ascites, vascular invasion, and TNM stage （all P〈0.05）. Cox hazards model analysis identified that TNM stage （HR=1.441, 95% CI=1.721-2.635, P〈0.001） and PLR level （HR=1.737, 95% CI=1.317-2.291, P〈0.001） were independent prognostic factors for HCC, and PLR level （HR=1.893, 95% CI=1.434-2.497, P〈0.001） was independent prognostic factor for HCC recurrence. Survival analysis showed that the preoperative 1-, 3- and 5-year tumor-free survival rate in patients with low preoperative PLR level （81.2%, 52.3% and 29.6%） were significantly higher than those in patients with higher preoperative PLR level （62.4%, 32.2% and 11.6%）. Conclusion： Preoperative PLR can be used as a prognostic marker for HCC patients, and those with high PLR level may have a high risk of recurrence and poor prognosis.