NLR、ALB和HBV-DNA对晚期肝细胞癌快速进展的预测价值

Predictive value of NLR,ALB and HBV-DNA in the rapid progression of advanced hepatocellular carcinoma

目的探讨中性粒细胞/淋巴细胞比值(NLR)、白蛋白(ALB)和乙肝病毒DNA(HBV-DNA)对晚期肝细胞癌(HCC)患者疾病快速进展的预测价值。方法回顾性分析2018年1月至2019年1月本院收治且经病理确诊的HBV相关晚期HCC患者60例,接受化疗、分子靶向药物或PD-1单抗治疗后根据无进展生存期(PFS)将患者分为快速进展组和非快速进展组各30例;收集并比较治疗前外周血NLR、总胆红素(TBIL)、ALB、前白蛋白(PA)、HBV-DNA、谷丙转氨酶(ALT)、乳酸脱氢酶(LDH)和甲胎蛋白(AFP)水平。通过受试者工作特征(ROC)曲线确定NLR的最佳截断值及其评估PFS的敏感度和特异度;采用Cox比例风险回归模型进行多因素分析。结果与非快速进展组相比,快速进展组患者的年龄更小,TBIL、LDH、AFP和NLR水平更高,而ALB和PA水平更低(P<0.05);两组间ALT水平和性别的差异无统计学意义(P>0.05),但快速进展组HBV-DNA>50 IU/ml及Child-pugh B7和A6分的患者更多(P=0.015、P=0.017)。ROC曲线显示NLR的最佳截断值为2.88,其中低NLR组24例,高NLR组36例。Cox比例风险回归分析结果发现,低NLR水平、HBV-DNA<50 IU/ml、ALB>35 g/L和AFP≤400 ng/ml是患者获得较长PFS的独立因素。结论NLR、ALB和HBV-DNA是晚期HCC疾病快速进展的独立预后因子,高水平NLR预示着姑息治疗后PFS较短,预后更差。

Objective To evaluate the predictive role of neutrophil to lymphocyte ratio(NLR),albumin(ALB)and hepatitis B virus DNA(HBV-DNA)for rapid disease progression in patients with advanced hepatocellular carcinoma(HCC).Methods From January 2018 to January 2019,60 patients with HBV-related HCC confirmed by pathologic detection were retrospectively analyzed.According to the progression-free survival(PFS)after systemic treatment including chemotherapy,targeted therapy or anti-PD-1,patients were divided into rapid progression group(n=30)and non-rapid progression group(n=30).Levels of peripheral NLR,total bilirubin(TBIL),ALB,prealbumin(PA),HBV-DNA,alanine aminotransferase(ALT),lactate dehydrogenase(LDH)and alpha fetoprotein(AFP)of HCC patients were collected and compared before treatment between both groups.The cut-off value of NLR as well as it's sensitivity and specificity were determined by receiver operating characteristic(ROC)curve.Cox proportional hazard model was used to determine the independent factors for patients'PFS.Results Compared with non-rapid progression group,patients in rapid progression group was younger with higher levels of TBIL,LDH,AFP and NLR as well as lower levels of ALB and PA(P<0.05).There were no significant differences in gender and ALT level between both groups.But there were more patients in rapid progression group with HBV-DNA>50 IU/ml and Child-Pugh B7/A6(P=0.015,P=0.017).The cut-off value of NLR was 2.88 according to ROC curve.There were 24 cases with NLR<2.88 and 36 cases with NLR≥2.88.Cox proportional hazard model showed that lower NLR level,ALB>35 g/L,HBV-DNA<50 IU/ml,and AFP≤400 ng/ml were independent factors for the longer PFS(P<0.05).Conclusion NLR,ALB and HBV-DNA were independent prognostic factors for the rapid disease progression in patients with advanced HCC.A higher NLR indicates that patients will suffer from a shorter PFS with poorer prognosis when given palliative treatment.