甲胎蛋白阴性肝细胞肝癌77例患者术前中性粒细胞与淋巴细胞比值对术后复发的预测价值分析

Predictive value of preoperative NLR in 77 patients with AFP-negative HCC after recurrence

目的 探究术前中性粒细胞与淋巴细胞比值（NLR）是否影响甲胎蛋白（AFP）阴性肝细胞肝癌（HCC）患者术后复发率及评估预后的价值.方法 分析2015年6月至2017年3月于我院诊断为AFP阴性HCC并行肝细胞肝癌手术77例患者的临床资料,根据随访截止时间的复发情况,将患者分为复发组与无复发组.使用Cox单因素分析两组患者的临床病理学特征和术后复发的关系,以及将单因素分析中具有统计学意义的临床危险因素放入Cox多因素回归分析中检测其是否为独立危险因素.结果 两组间肿瘤数目（31/15、28/3）、肿瘤大小（〉5 cm）（5.53±1.83、4.65±1.73）、门静脉癌栓（18/28、2/29）、微血管侵犯（14/32、2/29）,差异均有统计学意义（P〈0.05）.Cox单因素分析显示,术前NLR水平（RR=1.125,95%CI 1.052~1.203,P=0.029）、肿瘤数目（RR=0.943、95%CI 1.007~1.330,P=0.019）、肿瘤大小（〉5 cm）（RR=0.550,95%CI 0.316~0.956,P=0.038）、门静脉癌栓（RR=1.294,95%CI 1.208~1.386,P=0.022）、微血管侵犯（RR=1.575、95%CI 1.209~2.052,P=0.028）均是影响术后复发的危险因素.Cox多因素回归模型显示,肿瘤数目（RR=1.830,95%CI 1.184~2.828,P=0.026）、门静脉癌栓（RR=2.860,95%CI 2.062~3.968,P=0.001）、微血管侵犯（RR=1.760、95%CI 1.019~3.041,P=0.037）和术前NLR水平（RR=1.890,95%CI 1.056~3.383,P=0.028）为AFP阴性HCC患者术后复发的独立危险因素.本研究77例患者中,复发组共46例,NLR平均值为3.49±0.30;无复发组共31例,NLR平均值为3.01±0.30,两组NLR值之间的差别有统计学意义（t=-6.885,P=0.000）.根据ROC曲线,NLR=3.17时对应最大尤登指数,此时NLR的敏感度为82.6%,特异性为67.7%.结论 术前的NLR水平与AFP阴性HCC患者术后无复发生存时间呈反比,是其复发的独立危险因素之一,其最佳的临界取值为NLR=3.17.

Objective To assess the effect of neutrophil？to？lymphocyte ratio （ NLR） on the recurrence rate of patients with alpha？fetoprotein （AFP） ？negative hepatocellular carcinoma （HCC） and the value of NLR in predicting prognosis. Methods The clinical data of seventy？seven patients diagnosed with AFP？negative HCC and treated with hepatocellular carcinoma surgery in the First Hospital in Weinan from June 2015 to March 2017 were analyzed. According to the recurrence at the end of the follow？up, the patients were divided into the recurrence group and the non？recurrence group. Cox single factor analysis was used to analyze the relationship between the clinicopathological features and postoperative recurrence, and the clinical risk factors with statistically significance in the univariate analysis were placed in the Cox multivariate regression analysis to determine whether it is independent risk factor. Results The differences between the two groups in the number of tumors （31/15,28/3）,tumor size （〉5 cm） （5. 53±1. 83,4. 65±1. 73）,portal vein tumor thrombus （18/28,2/29）,microvascular invasion （14/32,2/29） were all statistically significant （P〈0. 05）. Cox univariate analysis showed that preoperative NLR levels （ RR=1. 125, 95%CI 1. 052-1. 203, P=0. 029 ） , tumor number （ RR=0. 943,95%CI 1. 007-1. 330, P=0. 019 ） , tumor size （〉5 cm ） （ RR=0. 550, 95%CI 0. 316-0. 956, P=0. 038）,portal vein tumor thrombus （RR=1. 294,95%CI 1. 208-1. 386,P=0. 022）,microvascular invasion （RR=1. 575,95%CI1. 209-2. 052,P=0. 028） were the risk factors of postoperative recurrence. Cox regression model showed that tumor number （RR=1. 830,95%CI 1. 184-2. 828,P=0. 026）,portal vein tumor thrombus （ RR=2. 860,95%CI 2. 062-3. 968,P=0. 001） ,microvascular invasion （ RR=1. 760,95%CI 1. 019-3. 041,P=0. 037） and preoperative NLR level （ RR=1. 890,95%CI 1. 056-3. 383,P=0. 028） were independent risk factors of the recurrence in AFP negative HCC patients after surgery. Among the 77 patients,46 cases were in the recurrent group, the average value of NLR was 3. 49 ± 0. 30, and the average preoperative NLR of the non？recurrence group （ 31 patients ） were 3. 01 ± 0. 30, the difference between the two groups in NLR value was statistically significant （t=-6. 885,P=0. 000）. According to the ROC curve,the NLR=3. 17 corresponded to the maximum Youden index,the sensitivity of NLR was 82. 6%,the specificity was 67. 7%. Conclusion The preoperative NLR level is inversely proportional to the recurrence？free survival time of patients with AFP？negative HCC,which is one of the independent risk factors for recurrence. The optimal critical value of NLR is 3. 17.