行肝切除术肝细胞癌患者炎性指标水平变化及与预后的相关性

Changes of inflammatory indicators and their correlations with the prognosis of patients undergoing hepatectomy for hepatocellular carcinoma

目的探讨肝细胞癌(hepatocellular carcinoma,HCC)患者肝切除术前后中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、血小板与淋巴细胞比值(platelet to lymphocyte ratio,PLR)、白蛋白与球蛋白比值(albumin to globulin ratio,AGR)差值与术后复发及死亡的关系。方法HCC患者144例,均首次行肝切除术,分别于术前1 d及术后第14天检测血常规,计算手术前后NLR、PLR、AGR差值,分别记为ΔNLR、ΔPLR、ΔAGR。将144例患者依据随访结果分为无复发组和复发组,生存组和死亡组,比较无复发组与复发组,生存组与死亡组的临床病理特征及血清学指标;Cox比例风险模型分析HCC患者术后复发或死亡的危险因素。结果144例患者随访5~62个月,中位随访37.63个月,复发63例,死亡57例。复发组肝硬化、微血管侵犯、肿瘤数>3个、肿瘤直径>5 cm、ΔNLR增高及ΔPLR增高比率(92.06%、73.02%、15.87%、71.43%、60.32%、55.56%)高于无复发组(77.78%、54.32%、4.94%、43.21%、41.98%、38.27%)(P<0.05)。死亡组年龄≥53岁、肝硬化、微血管侵犯、肿瘤数>3个、肿瘤直径>5 cm、ΔNLR增高、ΔPLR增高、总胆红素>15.65μmol/L比率(73.68%、94.74%、77.19%、15.79%、70.18%、70.18%、57.89%、82.46%)高于生存组(51.72%、77.01%、52.87%、5.74%、45.98%、36.78%、37.93%、56.32%)(P<0.05)。Cox比例风险模型分析结果显示,肝硬化(HR=1.025,95%CI:1.012-1.038,P<0.001)、微血管侵犯(HR=1.754,95%CI:1.232~2.485,P=0.002)、肿瘤直径>5 cm(HR=1.262,95%CI:1.061~1.465,P=0.027)、肿瘤数>3个(HR=1.713,95%CI:1.272~2.293,P<0.001,)、ΔNLR增高(HR=2.394,95%CI:1.532~3.724,P<0.001)、ΔPLR增高(HR=2.496,95%CI:1.156~5.389,P=0.020)是HCC患者术后复发的独立危险因素(P<0.05);肝硬化(HR=1.581,95%CI:1.151~2.172,P=0.005)、微血管侵犯(HR=1.781,95%CI:1.017~3.120,P=0.043)、肿瘤直径>5 cm(HR=1.922,95%CI:1.333~2.771,P<0.001)、ΔNLR增高(HR=2.115,95%CI:1.294~3.455,P<0.001)、ΔPLR增高(HR=1.552,95%CI:1.122~2.161,P=0.003)、总胆红素>15.65μmol/L(HR=1.717,95%CI:1.047~2.814,P=0.032)是HCC患者术后死亡的独立危险因素。结论HCC患者肝切除术后NLR、PLR升高提示预后不良。

Objective To investigate the differences of neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),and albumin to globulin ratio(AGR)before and after hepatectomy in patients with hepatocellular carcinoma(HCC),and their correlations with postoperative recurrence and death.Methods Totally 144 patients with HCC undergoing hepatectomy for the first time underwent routine blood test to calculate the differences of NLR,PLR and AGR(ΔNLR,ΔPLR,ΔAGR)1 day before and on the 14 th day after operation.According to the follow-up results,144 patients were divided into no-recurrence group and recurrence group,as well as survival group and death group.The clinicopathological features and serological indicators were compared between no-recurrence group and recurrence group,and between survival group and death group.Cox proportional hazards model was used to analyze the risk factors for postoperative recurrence or death in HCC patients.Results All patients were followed up for 37.63 months(5 to 62 months),showing recurrence in 63 patients and death in 57.The percentages of liver cirrhosis,microvascular invasion,number of tumors>3,tumor diameter>5 cm,ΔNLR increased andΔPLR increased were higher in recurrence group(92.06%,73.02%,15.87%,71.43%,60.32%,55.56%)than those in no-recurrence group(77.78%,54.32%,4.94%,43.21%,41.98%,38.27%)(P<0.05).The percentages of patient\s age≥53 years,liver cirrhosis,microvascular invasion,number of tumors>3,tumor diameter>5 cm,ΔNLR increased,ΔPLR increased and total bilirubin>15.65μmol/L were higher in death group(73.68%,94.74%77.19%,15.79%,70.18%,70.18%,57.89%,82.46%)than those in survival group(51.72%,77.01%,52.87%,5.74%,45.98%,36.78%,37.93%,56.32%)(P<0.05).Liver cirrhosis(HR=1.025,95%CI:1.012-1.038,P<0.001),microvascular invasion(HR=1.754,95%CI:1.232-2.485,P=0.002),tumor diameter>5 cm(HR=1.262,95%CI:1.061-1.465,P=0.027),number of tumors>3(HR=1.713,95%CI:1.272-2.293,P<0.001),ΔNLR increased(HR=2.394,95%CI:1.532-3.724,P<0.001),andΔPLR increased(HR=2.496,95%CI:1.156-5.389,P=0.020)were the independent risk factors for recurrence(P<0.05).Liver cirrhosis(HR=1.581,95%CI:1.151-2.172,P=0.005),microvascular invasion(HR=1.781,95%CI:1.017-3.120,P=0.043),tumor diameter>5 cm(HR=1.922,95%CI:1.333-2.771,P<0.001),ΔNLR increased(HR=2.115,95%CI:1.294-3.455,P<0.001),ΔPLR increased(HR=1.552,95%CI:1.122-2.161,P=0.003),and total bilirubin>15.65μmol/L(HR=1.717,95%CI:1.047-2.814,P=0.032)were the independent risk factors for death.Conclusion The increases of NLR and PLR after hepatectomy indicate a poor prognosis for HCC patients.