天冬氨酸氨基转移酶血小板比值可作为肝癌经肝动脉化疗栓塞术后的预后指标

Aspartate Transaminase and Platelet Ratio Index as a Prognostic Factor after Transarterial Chemoembolization for Hepatocellular Carcinoma

目的探讨天冬氨酸氨基转移酶血小板比值指数(APRI)与行经肝动脉化疗栓塞(TACE)治疗的肝癌患者的预后关系。方法回顾性分析388例肝癌患者的临床资料,根据TACE术前外周血APRI水平分为低APRI组(APRI<1.30,237例)和高APRI组(APRI≥1.30,151例),比较2组患者的1年及3年生存率。结果高APRI组的1年及3年生存率分别为25.5%和2.6%,低APRI组为71.2%和30.0%,2组间差别有统计学意义(P<0.001)。术前白蛋白及天冬氨酸氨基转移酶(AST)的水平、Child-Pugh分级、肿瘤大小、脉管癌栓、APRI、TACE次数是肝癌患者术后总生存时间的独立预后因素。经ROC曲线分析比较显示,APRI较其他临床预后因素有更大的ROC曲线下面积。结论 APRI可作为判断行TACE治疗的肝癌患者预后有价值的指标。

Objective To explore whether aspartate transaminase and platelet ratio index（APRI）is an effective prognostic marker after transarterial chemoembolization for hepatocellular carcinoma.Methods Retrospective analysis of clinical date in 388 patients with hepatocellular carcinoma. According to preoperative APRI,the patients were divided into the low APRI group（APRI〈1.30,n=237）and the high APRI group（APRI≥1.30,n=151）. The 1 or 3-year survival rates of the two groups were separately analyzed. Results The 1-year and 3-year survival rates in the high APRI group were 37.3% and19.0%respectively（P〈0.01）. In the low APRI group the survival rates were 57.6% and 38.2% respectively（P〈0.01）. The 1-year and 3-year recurrence rates in the high APRI group were 25.5% and2.6% respectively（P〈0.01）. In the low APRI group they were 71.2% and 30.0% respectively（P〈0.01）. In multivariate analysis,albumin level,Child-Pugh class,tumor size,vascular invasion,number of APRI,and APRI were independent predictors of hepatocellular carcinoma survival. ROC curve analysis showed that APRI had larger area under the ROC curve compared to other clinical prognostic factors. Conclusion Preoperative APRI may be a prognostic marker in patients with hepatocellular carcinoma after transarterial chemoembolization.