术前NLR联合AFP对肝细胞癌患者TACE术后预后的预测价值

Predictive value of preoperative neutrophil to lymphocyte ratio combined with alpha-fetoprotein on prognosis in patients with hepatocellular carcinoma after TACE

目的:探讨术前外周血中性粒细胞与淋巴细胞比值(Neutrophil to lymphocyte ratio,NLR)联合血清甲胎蛋白(Alpha fetoprotein,AFP)对肝细胞癌(Hepatocellular carcinoma,HCC)患者经导管动脉化疗栓塞(Transcatheter arterial chemoembolization,TACE)术后预后的预测价值。方法:选取235例接受TACE手术治疗的HCC患者作为研究对象,联合术前外周血NLR及血清AFP水平之后,将其分为4组,分析不同NLR联合AFP水平与临床病理特征的相关性,并比较4组患者的术后总体生存率(OS)和无瘤生存率(DFS)。结果:HCC患者TACE术前外周血NLR联合血清AFP水平与肿瘤直径、巴塞罗那(BCLC)分期和HBsAg等临床病理特征存在显著的相关性(P<0.05)。四组患者中,低NLR低AFP组的OS和DFS最高,而高NLR高AFP组最低,差异有统计学意义(P<0.05)。单因素和多因素Cox回归分析结果均显示:术前NLR联合AFP是影响HCC患者TACE术后预后的独立危险因素。结论:术前外周血NLR联合血清AFP可作为判断HCC患者TACE术后预后的可靠指标,并且术前外周血NLR和血清AFP水平均较高的患者预后较差。

Objective: To investigate the predictive value of preoperative neutrophil to lymphocyte ratio(NLR) in peripheral blood combined serum alpha-fetoprotein(AFP) on prognosis in patients with hepatocellular carcinoma(HCC) who received TACE.Methods: Two hundred and thirty five HCC patients were divided into four groups according to the preoperative peripheral blood NLR level and serum AFP level. The association of NLR combined with AFP level and clinicopathological features was analyzed. The overall survival rate(OS) and disease free survival rate(DFS) of these four groups were also compared. Results:The level of preoperative NLR combined with AFP was significantly associated with several clinicopathological characteristics,including maximum diameter of tumor, BCLC stage, and HBsAg level. Among the four groups, HCC patients with low NLR and low AFP exhibited the highest OS and DFS, whereas those with high NLR and high AFP showed the lowest OS and DFS. Both univariate and multivariate Cox regression analysis indicated that preoperative NLR combined with AFP level was an independent risk factor for worse prognosis. Conclusion: Preoperative NLR in peripheral blood combined with serum AFP can be a reliable indicator for prognosis in HCC patients who underwent TACE, and HCC patients with high level of preoperative NLR and serum AFP have a poor survival rate.