术前γ-谷氨酰转肽酶与淋巴细胞计数比值对肝癌术后预后的预测价值

Prognostic value of gamma-glutamyl transpeptidase to lymphocyte count ratio in patients with hepatocellular carcinoma after radical resection

目的探讨γ-谷氨酰转肽酶与淋巴细胞计数比值(GLR)对肝癌患者切除术后预后的预测价值。方法回顾性分析2010年1月至2016年12月期间接受肝切除术的328例肝癌患者的临床病理资料。以术前GLR中位数39.0作为界值,将患者分为高GLR组(GLR>39)和低GLR组(GLR≤39)。比较2组患者的临床病理资料、无复发生存率和总生存率的差异,并采用Cox比例风险回归模型分析影响预后的独立因素。结果GLR与白蛋白水平、谷丙转氨酶(ALT)、γ-谷氨酰转肽酶(GGT)、血小板计数、淋巴细胞计数、中性粒细胞与淋巴细胞比值(NLR)及肿瘤大小有关(P<0.05)。328例患者中,182例(55.5%)肿瘤复发,120例(36.6%)死亡。GLR>39组患者术后3、5、8年无复发生存率分别为43.3%、31.1%和18.0%,明显低于GLR≤39组的59.7%、49.2%和45.9%(P<0.001);GLR>39组患者术后3、5、8年生存率分别为70.7%、49.7%和34.5%,也明显低于GLR≤39组的85.3%、74.9%和68.2%(P<0.001)。Cox多因素回归分析结果显示,GLR>39是影响肝癌患者术后无复发生存和总生存时间的独立危险因素。结论术前GLR或许可以作为预测肝癌患者术后预后的一项参考指标。

Objective To investigate the predictive value of gamma-glutamyl transpeptidase to lymphocyte count ratio(GLR)in patients with hepatocellular carcinoma(HCC)after radical resection.Methods A retrospective analysis was performed on 328 patients with HCC who underwent radical resection between January 2010 and December 2016.Patients were divided into high GLR group(GLR>39)and low GLR group(GLR≤39)with a median GLR of 39.0.The clinicopathological data,recurrence free survival rate and overall survival rate were compared between the two groups.Cox proportional hazards regression model was used to analyze the independent factors affecting the prognosis of HCC patients.Results GLR was correlated with albumin level,alanine aminotransferase(ALT),gamma-glutamyl transpeptidase(GGT),platelet count,lymphocyte,neutrophil to lymphocyte ratio(NLR)and tumor size(P<0.05).Of the 328 patients,182(55.5%)patients had tumor recurrence and 120(36.6%)patients had died.The 3-,5-and 8-year recurrence free survival rates of patients with GLR>39 were 43.3%,31.1%and 18.0%,respectively,which were significantly lower than 59.7%,49.2%and 45.9%of patients with GLR≤39(P<0.001).The 3-,5-,and 8-year survival rates of patients with GLR>39 were 70.7%,49.7%and 34.5%,respectively,which were significantly lower than 85.3%,74.9%and 68.2%in GLR≤39 group(P<0.001).Cox multivariate analysis showed that GLR>39 was an independent risk factor for recurrence free survival(RFS)and overall survival(OS)in patients with HCC.Conclusion Preoperative GLR can be a predictive biomarker of HCC after radical resection.