系统免疫炎症指数和骨骼肌质量指数与肝硬化合并肝癌患者术后预后的关系

Postoperative prognostic significance of systematic immune-inflammation index and skeletal muscle mass index in patients with cirrhosis complicated with hepatocellular carcinoma

目的:探讨系统免疫炎症指数(SII)和骨骼肌质量指数(SMI)与肝硬化合并肝癌患者术后预后的关系。方法:选取2015年1月至2017年12月我院收治的128例肝癌合并肝硬化患者。比较不同水平SII和SMI组患者临床病理特征和预后,分析影响肝硬化合并肝癌患者术后预后的危险因素。结果:术前SII高水平组的BCLC分期、脉管癌栓占比、低分化占比高于低水平组,差异均有统计学意义(P<0.05)。术前SMI高水平组的年龄、美国麻醉医师协会分级、BCLC分期、肿瘤个数、脉管癌栓占比均低于或少于低水平组,差异有统计学意义(P<0.05)。术前SII低水平组1年、2年、3年累积总生存率分别为90.8%、75.5%、47.3%,术前SII高水平组1年、2年、3年累积总生存率分别为70.7%、58.2%、39.1%,差异有统计学意义(P=0.045)。术前SMI低水平组1年、2年、3年累积总生存率分别为73.3%、55.3%、34.8%,术前SMI高水平组1年、2年、3年累积总生存率分别为90.4%、77.8%、49.7%,差异有统计学意义(P=0.010)。Cox多因素分析结果显示,BCLC B-C期、多发肿瘤、低分化、脉管癌栓、术前高水平SII是患者术后预后的独立危险因素(P<0.05),根治性切除和术前高水平SMI是其独立保护因素(P<0.05)。结论:术前SII和SMI水平与肝硬化合并肝癌患者预后密切相关,高水平SII是其独立危险因素,而高水平SMI是其独立保护因素。

Objective:To explore the postoperative prognostic significance of systematic immune inflammation index(SII)and skeletal muscle mass index(SMI)in patients with cirrhosis complicated with hepatocellular carcinoma.Methods:128 patients with cirrhosis complicated with hepatocellular carcinoma admitted to our hospital from January 2015 to December 2017 were selected.The clinicopathological characteristics and prognosis of patients with different levels of SII and SMI were compared,and the risk factors affecting the postoperative prognosis of patients with cirrhosis complicated with hepatocellular carcinoma were analyzed.Results:Barcelona clinic liver cancer(BCLC)staging,proportion of vascular thrombus and low differentiation ratio in preoperative SII high-level group were higher than those in low-level group.The difference was statistically significant(P<0.05).The age,American Society of Anesthesiologists classification,BCLC staging,proportion of vascular cancer thrombus in the preoperative SMI high-level group were lower or less than those in low-level group.The difference was statistically significant(P<0.05).The 1-,2-,and 3-year overall survival rates were 90.8%,75.5%and 47.3%in preoperative low-level SII group respectively,and 70.7%,58.2%and 39.1%in high-level group(P=0.045).The 1-,2-,and 3-year overall survival rates were 73.3%,55.3%and 34.8%in preoperative low-level SMI group respectively,and 90.4%,77.8%and 49.7%in high-level group(P=0.010).Cox multivariate analysis showed that BCLC B-C stage,multiple tumors,poorly differentiated,vascular cancer thrombus and preoperative high-level SII were independent risk factors for the prognosis of patients(P<0.05),while radical resection and preoperative high-level SMI were independent protective factors(P<0.05).Conclusion:Preoperative SII and SMI levels are closely related to the prognosis of patients with cirrhosis complicated with hepatocellular carcinoma.High level of SII is an independent risk factor,while high level of SMI is an independent protective factor.