术前血小板与淋巴细胞比值对肝细胞癌患者预后影响的Meta分析

Prognostic value of preoperative platelet-to-lymphocyte ratio in patients with hepatocellular carcinoma: a Meta-analysis

目的系统评价术前外周血血小板/淋巴细胞比值(PLR)对肝细胞癌(HCC)患者预后的影响。方法计算机检索Medline、EMBASE、Cochrane Library、中国知网、中国生物医学文献数据库、维普及万方数据库,收集关于术前PLR与HCC预后相关性的研究。检索时限截至2017年1月,由2名研究者根据纳入与排除标准对文献进行独立筛选、提取资料和评价质量后,采用RevMan5.3软件进行Meta分析,各研究间的异质性分析采用χ~2检验。结果纳入符合标准的文献18篇,共4193例患者。Meta分析结果显示,高PLR组患者的总生存率明显低于低PLR组[HR=1.74,95%可信区间(95%CI):1.42~2.14,P<0.001],高PLR组患者的无瘤生存率或无复发生存率明显低于低PLR组(HR=1.76,95%CI:1.56~1.98,P<0.001)。亚组分析结果显示,在种族(亚洲人、高加索人)、治疗方法(手术、化疗、综合治疗)、样本量(≥200、<200)、PLR截断值(≥150、<150)及NOS评分(≥7、<7)等方面,高PLR组患者均明显低于低PLR组(P值均<0.05)。结论术前外周血高PLR与HCC患者的不良预后密切相关,PLR可作为评价HCC患者预后的指标。

Objective To systematically investigate the prognostic value of preoperative platelet-to-lymphocyte ratio（ PLR） in patients with hepatocellular carcinoma（ HCC）. Methods Medline,EMBASE,Cochrane Library,CNKI,CBM,VIP,and Wanfang Data were searched for studies assessing the association between preoperative PLR and prognosis of HCC published up to January 2017. Two reviewers independently screened the articles according to the inclusion and exclusion criteria,extracted data,and assessed methodological quality,and then a meta-analysis was performed using Rev Man 5. 3 software. The chi-square test was used for the analysis of heterogeneity between studies. Results A total of 18 articles with 4193 patients were included. The meta-analysis showed that compared with those with low PLR,patients with high PLR had significantly lower overall survival（ OS） rate（ hazard ratio [HR]= 1. 74,95% confidence interval[CI]1. 42-2. 14,P〈0. 001） and disease-free survival rate or relapse-free survival rate（ HR = 1. 76,95% CI： 1. 56-1. 98,P〈0. 001）. The subgroup analysis revealed that patients with high PLR had significantly shorter OS than those with low PLR,regardless of race（ Asian or Caucasian）,treatment method（ surgery,chemotherapy,or multimodality therapy）,sample size（ ≥200 or 〈200）,cut-off value of PLR（ ≥150 or 〈150）,and NOS score（ ≥7 or 〈7）（ all P〈0. 05）. Conclusion High preoperative PLR is closely associated with poor prognosis of HCC patients,suggesting that PLR might be a prognostic factor in HCC patients.