术前谷草转氨酶与淋巴细胞比值在原发性肝细胞癌R0切除预后评估中的价值

The Value of Preoperative Ratio of Glutamate Transaminase to Lymphocyte in the Prognosis Evaluation of R0 Resection of Primary Hepatocellular Carcinoma

目的探讨谷草转氨酶与淋巴细胞比值(ALRI)在原发性肝癌R0切除术后预后评估中的临床价值。方法回顾性分析2013年9月至2017年3月于西南医科大学附属第一医院行肝癌R0切除的原发性肝细胞癌(HCC)患者的临床病理资料,根据术前ALRI的受试者工作特征曲线(ROC曲线)确定ALRI的最佳临界值,并将患者分为高ALRI组(ALRI≥26. 06)和低ALRI组(ALRI<26. 06)。采用Log-rank单因素分析评估各临床病理特征包括ALRI对总生存期(OS)的影响,将有意义的变量进一步进行cox比例风险模型多因素分析。采用Kaplan-Meier生存分析法比较高ALRI组与低ALRI组患者生存时间及肿瘤复发情况,并使用log-rank检验差异。结果单因素分析结果显示肿瘤部位、肿瘤大小、肿瘤数目、分化程度、门静脉癌栓(PVTT)、TNM分期、出血量、微血管癌栓(MVI)、白蛋白、AFP、AST、ALRI是肝细胞癌患者R0切除术后OS的影响因素(P<0. 05); Cox多因素分析结果显示肿瘤大小、门静脉癌栓(PVTT)、TNM分期、ALRI是影响原发性肝细胞癌R0切除术后OS的独立危险因素(P<0. 05)。Kaplan-Meier生存分析法显示,低ALRI组较高ALRI组具有更好的OS及无瘤生存时间(DFS)(P<0. 001)。结论术前ALRI是影响原发性肝细胞癌患者R0切除术后总生存期的独立危险因素,对肝细胞癌术后预后评估可能具有较好的临床价值。

Objective To investigate the clinical value of the ratio of glutamate transaminase to lymphocyte(ALRI)in prognosis evaluation of R0 resection in primary hepatocellular carcinoma.Methods The clinical pathological data of patients with primary hepatocellular carcinoma(HCC)who underwent hepatic R0 resection in the First Affiliated Hospital of Southwest Medical University from September 2013 to March 2017 were retrospectively analyzed.The optimal cut-off value for ALRI was determined according to the preoperative receiver operating characteristic curve(ROC curve)and the patients were divided into high ALRI group(ALRI≥26.06)and low ALRI group(ALRI﹤26.06).Log-rank univariate analysis was used to evaluate the impact of various clinicopathological features including ALRI on overall survival(OS),and meaningful variables were further analyzed by cox proportional hazard model multivariate analysis.Kaplan-Meier survival analysis was used to compare survival time and tumor recurrence between patients with high ALRI and low ALRI and the difference was analyzed by log-rank test.Results Univariate analysis showed that tumor site,tumor size,tumor number,degree of differentiation,portal vein tumor thrombus(PVTT),TNM staging,hemorrhage volume,microvascular tumor thrombus(MVI),albumin,AFP,AST and ALRI were influencing factors of OS in patients with hepatocellular carcinoma after R0 resection(P﹤0.05);Cox multivariate analysis showed that tumor size,portal vein thrombosis(PVTT),TNM staging and ALRI were independent influencing factors of OS in patients with hepatocellular carcinoma after R0 resection(P﹤0.05).Kaplan-Meier survival analysis showed that the high ALRI group had better OS and tumor-free survival time(DFS)than the lower ALRI group(P﹤0.001).Conclusion Preoperative ALRI is an independent influencing factor of OS in patients with hepatocellular carcinoma after R0 resection which may have a good clinical value for postoperative prognosis evaluation of hepatocellular carcinoma.