中性粒细胞与淋巴细胞比值及其动态变化对经肝动脉化疗栓塞术治疗的肝细胞癌患者预后的预测价值

Predictive value of neutrophil-lymphocyte ratio and its dynamic change in patients with hepatocellular carcinoma undergoing transarterial chemoembolization

目的探讨中性粒细胞与淋巴细胞比值(NLR)及其动态变化在经肝动脉化疗栓塞术(TACE)治疗肝细胞癌(HCC)中的预测价值。方法将2010年1月-2014年12月在第四军医大学西京消化病医院诊断为HCC并接受TACE治疗的患者纳入研究,收集基线、术后3 d,术后1个月的中性粒细胞与淋巴细胞比值(NLR)等因素。采用受试者工作特征曲线确定NLR的最佳界值。计量资料组间比较采用t检验,计数资料采用χ2检验,生存时间组间比较应用Kaplan-Meier法,单因素、多因素Cox回归分析进行预后分析。结果共纳入427例HCC患者。基线NLR的中位值为2.4;术后3 d,NLR值增高,中位值达6.2;术后1个月,NLR值降至基线水平。基线、术后3 d和术后1个月预测生存的最佳分界值分别为2.5、9.7和2.5。基线、术后3 d、术后1个月低NLR组和高NLR组中位生存时间差异有统计学意义(χ2=10.529、8.388、6.679,P值均<0.05)。多因素Cox回归分析显示:基线NLR>2.5是HCC患者生存差的独立预测因素。基线和术后3 d NLR都低组、基线或术后3 d NLR高组、基线和术后3 d NLR都高组中位生存时间分别为28.0、21.0和10.1个月,组间差异有统计学意义(χ2=19.846,P<0.001)。基线和术后1个月NLR都低组、基线或术后1个月NLR高组、基线和术后1个月NLR都高组中位生存时间分别为29.4、21.0和15.4个月,组间差异有统计学意义(χ2=11.424,P=0.003)。结论基线及NLR的动态变化可以作为判断TACE治疗HCC预后的评估指标。

Objective To investigate the predictive value of neutrophil - lymphocyte ratio （NLR） and its dynamic change in patients with hepatocellular carcinoma （ HCC ） undergoing transarterial chemoembolization （ TACE ）. Methods The patients who were diagnosed with HCC and treated with TACE in Xijing Hospital of Digestive Disease of Fourth Military Medical University from January 2010 to December 2014 were enrolled. The factors including NLR were recorded at baseline and 3 days and 1 month after TACE. The receiver operating char- acteristic （ROC） curve was used to determine the cut - off value of NLR. The t - test was used for comparison of continuous data between groups, the chi - square test was used for comparison of categorical data between groups, the Kaplan - Meier method was used to calculate survival rates, and univariate and multivariate Cox regression analyses were used for prognostic analysis. Results A total of 427 patients were enrolled. The median value of baseline NLR was 2.4 ; at 3 days after surgery, NLR increased and the median value reached 6.2 ; at 1 month after surgery, NLR decreased to the baseline level. The cut - off values at baseline, 3 days after surgery, and 1 month after surgery were 2.5,9.7, and 2.5, respectively. At baseline, 3 days after surgery, and 1 month after surgery, the median survival time showed signif- icant differences between the low - NLR group and the high - NLR group （X2 = 10. 529, 8. 388, and 6.679, all P 〈 0.05）. The multivari- ate Cox regression analysis showed that the baseline NLR 〉 2.5 was the independent predictor for survival difference in HCC patients. In the group with low NLR at baseline and 3 days after surgery, the group with high NLR at baseline or 3 days after surgery, and the group with high NLR at baseline and 3 days after surgery, the median survival time was 28.0, 21.0, and 10.1 months, respectively, and showed a sig- nificant difference between groups （x2= 19. 846, P 〈0.001 ）. In the group with low NLR at baseline and 1 month after surgery, the group with high NLR at baseline or 1 month after surgery, and the group with high NLR at baseline and 1 month after surgery, the median survival time was 29.4, 21.0, and 15. g months, respectively, and showed a significant difference between groups （X2 = 11. 424, P =0.003 ）. Conclusion Baseline NLR and its dynamic change can be used to predict the prognosis in HCC patients receiving TACE.