血小板/脾最大径比值在预测肝细胞癌术后长期复发中的作用

The Role of Platelet/Spleen Diameter Ratio in Predicting Long-term Recurrence of Hepatocellular Carcinoma after Hepatectomy

目的研究血小板/脾最大径比值(PSR)在预测肝细胞癌(HCC)术后长期复发中的作用。方法回顾性分析郑州大学第一附属医院肝胆外科2012年1月1日至2016年12月31日行肝脏切除并经病理证实为HCC的119例患者的临床资料。收集术前临床及病理学资料,并进行术后随访。使用Cox比例风险回归及Kaplan—Meier法分析HCC术后长期复发的危险因素及进行生存率的比较。结果单因素分析结果显示:HCC患者手术切除后长期复发与脾最大径、血清甲胎蛋白(AFP)水平、PSR相关(P<0.05),与年龄、性别、血清谷丙转氨酶(ALT)水平、肿瘤最大直径、肿瘤数量、门脉有无癌栓、肿瘤位置及是否合并HBV或HCV等因素无关(P<0.05)。多因素分析结果显示:AFP≥400μg·L^-1(HR=3.369,95.0%CI为1.225~9.261,P=0.019)、PSR≤909(HR=3.142,95.0%CI为1.194~8.271,P=0.020)是原发性肝癌患者手术切除后长期复发的独立危险因素。PSR>909组的生存率高于PSR≤909组,差异有统计学意义(χ^2=30.747,P<0.001)。结论PSR≤909、AFP≥400μg·L^-1的HCC患者术后长期复发风险增加,且PSR≤909的HCC患者术后长期生存率降低。PSR≤909在预测HCC术后长期复发方面有一定的指导意义。

Objective To study the role of platelet/spleen diameter ratio(PSR)in predicting long-term recurrence of hepatocellular carcinoma(HCC)after hepatectomy.Methods The clinical date of 119 patients who underwent liver resection and were pathologically confirmed as HCC from January 1,2012 to December 31,2016 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed.The clinical data before surgery and pathological data were collected and were postoperative followed-up.Cox proportional hazard regression(Cox)and kaplan-Meier method were used to analyze the risk factors for long-term recurrence of HCC after surgery and compare survival rates.Results The results of univariate analysis showed that the long-term recurrence of HCC patients after surgical resection was statistically significant in relation to the maximum diameter of the spleen,serum AFP level and PSR(P<0.05),but it was not statistically significant in relation to age,gender,serum ALT level,maximum diameter of tumor,tumor number,portal vein thrombus,tumor location and HBV or HCV infecting.The results of multivariate analysis showed that AFP≥400μg·L^-1(HR=3.369,95.0%CI 1.225-9.261,P=0.019)and PSR≤909(HR=3.142,95.0%CI 1.194-8.271,P=0.020)were independent risk factors for long-term recurrence of HCC patients after surgical resection.Survival rate of group>909 was higher than that of group PSR≤909(χ^2=30.747,P<0.001).Conclusion Patients with PSR≤909 and AFP≥400μg·L^-1 have an increased risk of long-term recurrence after HCC surgery,and the long-term survival rate of HCC patients with PSR≤909 decreases after HCC surgery.PSR≤909 has certain guiding significance in predicting long-term recurrence after HCC surgery.