术前中性粒细胞／淋巴细胞比值在甲胎蛋白阴性肝细胞肝癌术后复发中的预测价值

Preoperative neutrophil-to-lymphocyte ratio is an independent prognostic predictor for AFP negative hepatocellular carcinoma after hepatectomy

目的评价术前外周血中性／淋巴细胞比值（neutrophil-to-lymphocyte ratio，NLR）对甲胎蛋白（alpha．fetoprotein，AFP）阴性肝细胞肝癌（hepatocellular carcinoma，HCC）术后复发的影响及预测价值。方法回顾性分析2010年9月至2013年1月我院68例行手术治疗的AFP阴性HCC患者的临床病理资料并随访预后，根据ROC曲线以NLR=2．78为临界值将患者分为低NLR组（NLR〈2．78）和高NLR组（NLRt〉2．78），Logrank单因素分析两组患者临床病理因素与无复发生存时间的关系，将有统计学意义的单因素导入Cox回归模型进行风险分析。结果本组68例患者1、2、3年无复发生存率分别为79．7％、37．5％、18．2％，其中高NLR组分别为70．3％、35．1％、13．5％，低NLR组分别为85．2％、40．7％、18．5％。2组差异有统计学意义（P=0．042）。单因素分析显示高NLR比值，肿瘤〉5cm，微血管侵犯以及合并肝硬化是影响术后无复发生存时间的危险因素，Cox回归分析提示以上四个因素均为影响术后复发的独立危险因素。结论术前高NLR是影响AFP阴性HCC患者术后复发的独立危险因素之一。

Objective To evaluate the prognostic value of preoperative neutrophil-to-lymphocyte ratio （NLR） on recurrence after hepatectomy for AFP negative hepatocellular carcinoma （HCC）. Methods Clinical data of 68 AFP negative HCC patients undergoing radical hepatectomy from September 2010 to January 2013 were analyzed retrospectively. According to preoperative NLR, patients were divided into low NLR group （ NLR 〈 2. 78 ） and high NLR group （ NLR≥2. 78 ）, respectively. Univariate analysis was performed to assess for a significant difference in clinicopathological characteristics influencing disease-free survival after hepatectomy. A muhivariate analysis was performed by Cox regression for variables significant on univariate analysis. Kaplan-Meier method was used to assess disease-free survival rate. Results The overall 1, 2, and 3-year disease-free survival rate was 79.7% , 37.5%, and 18.2% respectively. The disease-free survival of high NLR group was significantly lower than the low NLR group （ 1, 2, and 3-year overall survival were 70. 3% , 35. 1% , and 13.5% vs 85.2% , 40. 7% , and 18.5% , respectively, P = O. 042）. Preoperative NLR t〉2.78, tumor size （ 〉 5 era）, microvascular invasion and liver cirrhosis were risk factors of poor disease-free survival. Cox regression analysis revealed that all of these four factors were independent predictors of poorer disease-free survival. Conclusions Preoperative NLR≥2. 78 was one of independent adverse predictors for disease-free survival in AFP negative HCC patients after hepatectomy.