ALBI分级和NLR对HBV相关肝细胞癌患者肝移植预后的影响

Role of albumin-bilirubin grade and neutrophil-lymphocyte ratio in the prognosis of patients with hepatitis B virus related hepatocellular carcinoma after liver transplantation

目的探讨术前白蛋白-胆红素(ALBI)分级和外周血中性粒细胞与淋巴细胞比值(NLR)对乙型病毒肝炎(HBV)相关肝细胞癌(HCC)患者肝移植预后的影响。方法收集2007年1月至2018年12月接受肝移植术的41例HBV相关HCC患者的临床资料,根据术前1周内的白蛋白和胆红素计算ALBI,中性粒细胞和淋巴细胞计数的比值计算NLR,通过受试者工作特征(ROC)曲线确定NLR的截点值。通过Log-rank检验对影响HCC移植术后预后的相关因素进行单因素分析,采用Cox比例风险回归模型进行多因素分析。结果HCC肝移植术后的中位生存时间(OS)为62.0个月,无病生存时间(DFS)为28.3个月。ALBI分级1级组患者肝移植后中位OS和中位DFS分别为105.7(95%CI:80.036~131.364)个月和99.4(95%CI:8.834~189.966)个月,较ALBI分级2~3级组患者的27.4(95%CI:4.786~50.014)个月和8.9(95%CI:0.983~16.817)个月明显延长,差异有统计学意义(P均<0.05)。NLR低水平组肝移植术后中位OS和中位DFS分别为85.9个月和83.7个月,较NLR高水平组的32.8(95%CI:21.265~44.335)个月和11.0(95%CI:0.201~21.799)个月明显延长,差异有统计学意义(P均<0.05)。ALBI分级1级且NLR低水平组的HCC患者肝移植术后生存最佳。单因素分析结果显示,性别、术前AFP水平、NLR水平和ALBI分级对HCC肝移植后的生存有影响(P<0.05);Cox多因素回归分析结果显示,性别和术前AFP水平是影响HCC肝移植术后OS的独立因素。结论ALBI分级联合NLR水平可作为预测HBV相关HCC移植术后预后的参考指标。

Objective To evaluate the effect of preoperative albumin-bilirubin(ALBI)grade and neutrophil-lymphocyte ratio(NLR)on the survival of hepatitis B virus(HBV)related hepatocellular carcinoma(HCC)after liver transplantation(LT).Methods Between January 2007 to December 2018,41 patients were diagnosed HBV related HCC and treated with LT.Preoperative peripheral blood test results within a week were used to calculate ALBI grade and NLR.The cut-off value of NLR was identified through the receiver operating characteristic(ROC)curve.Univariate analysis was performed by Log-rank test and multivariate analysis was performed by Cox proportional hazards regression model.Results Of the 41 patients,the median overall survival(OS)was 62.0 months,the median disease-free survival(DFS)was 28.3 months.The median OS and DFS were 105.7(95%CI:80.036-131.364)months and 99.4(95%CI:8.834-189.966)months in ALBI grade 1 group,which were significantly longer than 27.4(95%CI:4.786-50.014)months and 8.9(95%CI:0.983-16.817)months in ALBI grade 2-3 group(all P<0.05).The median OS and DFS after LT were 85.9 months and 83.7 months in NLR low level group,which were significantly longer than 32.8(95%CI:21.265-44.335)months and 11.0(95%CI:0.201-21.799)months in NLR high level group(all P<0.05).The HCC patients with ALBI grade 1 and NLR low level had the longest survival after LT.Univariate results showed that gender,preoperative AFP level,NLR level and ALBI grade had an impact on the survival of HCC patients after LT(P<0.05).Cox multivariate analysis showed that gender and preoperative AFP level were independent factors influencing OS of HCC patients after LT.Conclusion ALBI grade and NLR can be used to predict the prognosis of patients with HBV related HCC after LT.