术前SIRI和PLR对肝癌切除术后病人生存预测价值分析

Predictive significance of preoperative SIRI combined with PLR in postoperative patients with hepatocellular carcinoma

目的联合术前中性粒细胞×单核细胞/淋巴细胞比值(SIRI)与血小板/淋巴细胞比值(PLR),探讨两指标对肝癌病人术后无瘤存活率与总存活率的预测意义。方法回顾性分析2011—2012年河南省郑州大学第一附属医院行原发性肝癌切除且术后病理学检查结果均提示肝细胞肝癌的126例病人资料、术前实验室检验、影像学检查、手术记录等,计算每例病人术前SIRI与PLR指标,并进行随访观察,通过单因素及多因素分析明确以上因素对于病人无瘤存活率与总存活率的预测意义。结果术前SIRI与PLR对于肝癌病人术后具有较准确的预测价值,SIRI诊断肿瘤的ROC曲线下面积为0.673,PLR的曲线下面积为0.722。术前外周血SIRI和PLR水平与肝癌巴塞罗那分级(BCLC)分期、肿瘤直径、血管侵犯等相关(P均<0.05)。Cox风险模型提示术前SIRI及PLR均为肝癌预后及复发的独立影响因素。生存分析表明,SIRI≤1.335组及PLR≤72.9组病人的1、3、5年无瘤存活率及总存活率均高于SIRI>1.335组与PLR>72.9组。当术前SIRI>1.335,PLR>72.9时,病人表现出最差的预后情况,提示病人可能存在术后高复发与高死亡风险。结论术前SIRI及PLR是两种较为可靠的预测指标,可用于预测肝癌病人术后生存情况,两者结合更有利于提高预测的准确性。

Objective To combine preoperative neutrophil×monocyte/lymphocyte ratio（SIRI）and platelet/lymphocyte ratio（PLR）, investigate the value of predicting tumor-free survival rate and overall survival rate in hepatocellular carcinoma（HCC） patients after curative hepatectomy. Methods The clinical data of 126 HCC patients in the First Affiliated Hospital of Zhengzhou University from 2011 to 2012 underwent surgical treatment and postoperative pathological results all suggesting hepatocellular carcinoma were analyzed retrospectively. Patients′ medical data, preoperative laboratory tests, imageological data, surgery records were collected. The preoperative SIRI and PLR ratio of each patients were calculated, and follow-up was observed for each patients. Univariate and multivariate analysis were performed to identify the predictive value of above factors for tumor-free survival rate and overall survival rate. Results Indicators SIRI and PLR had a real accurate predictive value for HCC patients. The area under the curve of ROC of SIRI for diagnosis of tumor recurrence was 0.673, and that of PLR is 0.722. The preoperative SIRI and PLR level were significantly associated with the clinicopathologic factors that include BCLC stage, tumor size, vascular invasion, and so on（all P〈0.05）. Cox hazards models analysis identified that preoperative SIRI and PLR level were independent prognostic factors for HCC recurrence and prognosis. Survival analysis showed that postoperative 1-, 3-, 5-year tumor-free survival rate and 1-,3-,5-year overall survival rate in patients with preoperative SIRI≤1.335 and PLR≤72.9 were significantly higher than those in patients with SIRI〉1.335 and PLR〉72.9. When the radio SIRI〉1.335 and PLR〉72.9, patients showed the worst prognosis, suggesting that patients might have a high risk of recurrence and poor prognosis. Conclusion Preoperative SIRI and PLR are two reliable predictors, which can be used to predict the survival of HCC patients after surgical resection. The combination of SIRI and PLR increases the prognostic accuracy of testing.