术前白细胞计数预测肝切除治疗超“米兰标准”肝细胞癌病人的预后

Preoperative white blood cell count predicts prognosis in patients with hepatocellular carcinoma beyond Milan criteria after hepatic resection

目的:探讨术前白细胞计数对超"米兰标准"肝细胞癌病人肝切除预后的预测价值。方法:回顾性分析2007年6月至2013年12月在天津医科大学肿瘤医院行肝切除的237例超"米兰标准"肝细胞癌病人的临床资料。利用ROC曲线确定白细胞计数分界值,对病人分组。应用Kaplan-Meier法制作生存曲线,Log-Rank法进行分析。应用COX比例风险模型研究影响预后的危险因素。结果:白细胞计数6.0×109/L为分界值。白细胞较低组和白细胞较高组中位生存时间分别为53.4个月和27.6个月(P=0.002)。白细胞较低组和白细胞较高组中位无复发生存时间分别为20.7个月和12.2个月(P=0.029)。匹配分析后两组间生存时间及无复发生存时间仍有统计学差异。结论:术前白细胞计数可预测超"米兰标准"肝细胞癌病人肝切除的预后。

Objective To study the prognostic value of preoperative white blood cell（WBC） count in patients with hepatocellular carcinoma（HCC） beyond Milan criteria after hepatic resection.Methods Clinical data of 237 patients with HCC beyond Milan criteria from Tianjin Medical University Cancer Hospital who underwent hepatectomy from June 2007 to December 2013 were retrospectively studied.The cut-off value of WBC count was determined by receiver operating characteristic curve,which was used to divide the patients in two groups.Survival curves were formed with Kaplan-Meier method and were analyzed using Log-Rank test.Cox proportional hazards model was developed to identify the risk factors of survival.Results WBC count 6.0 ×10^9/L was the cut-off point between two groups.The median survival time of lower WBC count group and higher WBC count group were 53.4 and 27.6 months,respectively（P=0.002）.The median recurrence-free survival of lower WBC count group and higher WBC count group were 20.7 and 12.2 months,respectively（P=0.029）.The statistical differences in both survival time and recurrence-free survival remained between two groups after match analysis.Conclusions Preoperative WBC count might predict the prognosis of HCC patients beyond Milan criteria after hepatic resection.