肝细胞癌术前血清AFP与NLR水平对判断患者预后的应用价值

Value of preoperative serum AFP and NLR levels in predicting prognosis of HCC patients

目的探讨肝细胞癌(HCC)术前血清甲胎蛋白(AFP)与中性粒细胞与淋巴细胞比值(NLR)水平判断患者预后的价值。方法回顾性分析2014年2月~2016年2月收治的88例于我院行手术治疗的HCC患者的临床资料,依据预后情况分为预后良好组与预后不良组。比较两组性别、年龄、TNM分期、肿瘤直径、是否存在淋巴结转移、是否存在乙型肝炎病毒感染、AFP、NLR差异,通过ROC曲线分析AFP、NLR预测HCC患者预后不良的价值,最后通过多因素logistic回归分析明确HCC预后不良的危险因素。结果两组性别、年龄、是否存在乙型肝炎病毒感染对比无差异(P>0.05);预后不良组TNM分期Ⅲ或Ⅳ期、肿瘤直径≥60 mm、淋巴结转移患者显著多于预后良好组,(P<0.05);预后不良组AFP、NLR显著高于预后良好组,(P<0.05)。经ROC分析AFP、NLR预测HCC患者预后的曲线下面积分别为0.839、0.815,均有P<0.05。经多因素logistic回归分析证实,TNM分期Ⅲ或Ⅳ期、肿瘤直径≥60 mm、淋巴结转移、AFP≥444.26 ng/mL、NLR≥2.65是HCC患者预后不良的危险因素,均有P<0.05。结论HCC的预后影响因素较多,当AFP≥444.26 ng/mL、NLR≥2.65时HCC患者预后较差,临床治疗中应当关注。

Objective To evaluate the predictive value of preoperative serum alpha-fetoprotein(AFP)level and neutrophil-to-lymphocyte ratio(NLR)in the prognosis of patients with hepatocellular carcinoma(HCC).Methods The clinical data of 88 patients with HCC who underwent surgery in our hospital from February 2014 to February 2016 were retrospectively analyzed.According to the prognosis,they were divided into a good prognosis group and a poor prognosis group.The gender,age,the tumor,node,metastasis(TNM)stage,tumor diameter,lymph node metastasis,hepatitis B virus infection,AFP,and NLR between the 2 groups were compared.The value of AFP and NLR in predicting poor prognosis of HCC patients was analyzed by receiver operator characteristic curve.And risk factors for poor prognosis of HCC were identified by multivariate logistic regression analysis.Results There was no difference between the 2 groups in sex,age or the incidence of hepatitis B virus infection(P>0.05).In poor prognosis group,cases of TNM stage III or IV,tumor diameter≥60 mm and lymph node metastasis were significantly more than those in good prognosis group(P<0.05).AFP and NLR in poor prognosis group were significantly higher than those in good prognosis group(P<0.05).The area under the curve of AFP and NLR predicting the poor prognosis of HCC patients was 0.839 and 0.815,respectively(P<0.05).Multivariate logistic regression analysis confirmed that TNM stage III or IV,tumor diameter≥60 mm,lymph node metastasis,AFP≥444.26 ng/mL,NLR≥2.65 were risk factors for poor prognosis of HCC patients(P<0.05).Conclusion The prognosis of HCC is affected by many factors.When AFP≥444.26 ng/mL or NLR≥2.65,the prognosis of HCC patients tends to be poor,which should be paid attention to in clinical treatment.