中性粒细胞/淋巴细胞比值对肝细胞癌患者肝移植术后无复发生存的预测价值

The value of neutrophils-lymphocytes ratio in predicting recurrence-free survival in patients with hepatocellular carcinoma after liver transplantation

目的:探讨中性粒细胞/淋巴细胞比值(NLR)对肝细胞癌患者肝移植术后无复发生存的预测价值。方法:回顾性分析中国人民解放军联勤保障部队第九〇〇医院2012年1月至2019年12月连续收治的接受肝移植的84例肝细胞癌患者临床资料,其中男性73例,女性11例,平均51岁。单因素和多因素Cox回归分析术后无复发生存的危险因素。受试者工作特征(ROC)曲线确定NLR预测术后无复发生存的最佳界值,以此分组比较无复发生存率。结果:NLR预测肝细胞癌患者肝移植术后无复发生存的ROC曲线下面积为0.683,约登指数0.319,最佳界值为3.2。单因素分析显示肿瘤最大直径、肿瘤数目、米兰标准、NLR与肝细胞癌患者肝移植术后无复发生存相关(均 P<0.05)。多因素分析显示:肿瘤最大直径( HR=2.412,95% CI:1.277~4.555)、肿瘤数目≥3个( HR=5.595,95% CI:2.023~17.531)和NLR≥3.2( HR=2.891,95% CI:1.348~6.204)是肝细胞癌患者肝移植术后无复发生存的独立危险因素(均 P<0.05)。以NLR 3.2为界值分组,NLR<3.2组( n=61)肝移植术后1年累积无复发生存率78%,优于NLR≥3.2组( n=23)的58%,差异有统计学意义( P<0.05)。 结论:肿瘤最大直径、肿瘤数目和NLR与肝细胞癌患者肝移植术后无复发生存相关。NLR对肝细胞癌患者肝移植术后无复发生存有一定的预测价值。

Objective To investigate the predictive effect of neutrophil to lymphocyte ratio(NLR)for recurrence-free survival after liver transplantation in hepatocellular carcinoma(HCC)patients.Methods The clinical data of 84 HCC patients who underwent liver transplantation in the 900th Hospital of the Joint Logistics Team,PLA,from January 2012 to December 2019 were included in this retrospective analysis.There were 73 males and 11 females,with an average age of 51 years.Univariate and multivariate Cox regression analyses were performed.The distinguishing ability of NLR for predicting recurrence-free survival in patients with HCC after liver transplantation was analyzed using the receiver operating characteristic(ROC)curvee.The two groups were generated according with the cut-off value,and the recurrence-free survival time to make the Kaplan-Meier survival curve.Results The area under the ROC curve of NLR for predicting recurrence-free survival after liver transplantation in patients with HCC was 0.683,Yoden index was 0.319,and the optimal threshold was 3.2.Univariate analysis showed that maximum tumor diameter,number of tumors,Milan criteria,and NLR were associated with recurrence-free survival after liver transplantation in patients with HCC(all P<0.05).Multivariate analysis showed that maximum tumor diameter(HR=2.412,95%CI:1.277-4.555),number of tumors≥3(HR=5.595,95%CI:2.023-17.531)and NLR≥3.2(HR=2.891,95%CI:1.348-6.204)were independent risk factors for recurrence-free survival of HCC patients prediction after liver transplantation(all P<0.05).The 1-year recurrence-free survival rate was 78%in the NLR<3.2 group(n=61),which was superior to 58%in the NLR≥3.2 group(n=23),and the difference was statistically significant(P<0.05).Conclusion Tumor diameter,number of tumors and NLR are risk factors affecting the prognosis of liver transplantation in patients with HCC,and high serum NLR may indicate recurrence-free survival in patients with HCC after liver transplantation.