术前预后营养指数评估肝细胞癌患者肝切除术后早期肿瘤复发价值探讨

Prediction of early tumor recurrence by predictive nutritional index in patients with hepatocellular carcinoma undergoing hepatectomy

目的探讨术前预后营养指数(PNI)和中性粒细胞/淋巴细胞比值(NLR)评估肝细胞癌(HCC)患者在肿瘤切除术后早期肿瘤复发的价值。方法2012年1月~2015年12月诊治的HCC患者237例,均接受肝癌切除术。根据术前检查结果计算PNI和NLR,绘制受试者工作特征(ROC)曲线,由最高约登指数确定截断点,比较不同PNI和NLR组患者临床和病理学特征。应用单因素和多因素Logistic回归分析影响HCC术后早期肿瘤复发的因素。结果本组高PNI组(≥45.95)128例,低PNI组(<45.95)109例,高NLR组(≥2.52)99例,低NLR组(<2.52)138例;高PNI组术后早期肿瘤复发率为51.6%(66/128),显著低于低PNI组的73.4%(80/109,P<0.01),低NLR组早期肿瘤复发率为55.8%(77/138),显著低于高NLR组的69.7%(69/99,P<0.05);经单因素和多因素Logistic回归分析发现高PNI(HR=2.036,95%CI=1.113~3.722,P=0.021)、低NLR(HR=2.235,95%CI=1.221~4.091,P=0.009)和TNM分期晚(HR=2.540,95%CI=1.237~5.215,P=0.011)是肝癌根治术后早期肿瘤复发的独立危险因素。结论高PNI和低NLR对预测HCC患者术后早期肿瘤复发具有潜在的应用价值。

Objective The aim of this study was to investigate the prediction of early tumor recurrence by predictive nutritional index(PNI)and neutrophil/lymphocyte ratio(NLR)in patients with hepatocellular carcinoma(HCC)undergoing hepatectomy.Methods The clinical data of 237 patients with HCC were recruited in Anhui Provincial Hospital between January 2012 and December 2015,and all patients underwent partial hepatectomy.The PNI and NLR receiver operating characteristic curves(ROC)were plotted.Multivariate Logistic analysis was applied to predict the risk factors for postoperative early tumor recurrence.Results There were 128 patients with high(≥45.95)and 109 patients with low PNI score(<45.95),and 99 patients with high(≥2.52)and 138 patients with low NLR score(<2.52);the early tumor recurrence rate in patients with high PNI score was 51.6%(66/128),much lower than 73.4%(80/109)in those with low PNI score(P<0.01),and the early tumor recurrence rate in patients with low NLR score was 55.8%(77/138),significantly lower than 69.7%(69/99)in those with high NLR score(P<0.05);Univariate and multivariate Logistic regression analysis showed high PNI score(HR=2.036)95%CI=1.113-3.722,P=0.021),low NLR score(HR=2.235,95%CI=1.221-4.091,P=0.009)and advanced TNM staging(HR=2.540,95%CI=1.237-5.215,P=0.011)were the independent risk factors for early tumor recurrence after radical resection of liver cancer.Conclusion The calculation of PNI and NLR pre-operationally might help predict the early tumor recurrence after hepatectomy in patients with HCC.