高密度脂蛋白胆固醇对行根治性治疗的酒精相关性肝细胞癌患者预后的影响

Influence of high-density lipoprotein cholesterol on the prognosis of patients with alcohol-related hepatocellular carcinoma after radical treatment

目的探索高密度脂蛋白胆固醇(HDL-C)与根治性治疗后酒精相关性肝细胞癌(HCC)患者预后的关系。方法回顾性分析2008年1月—2015年7月解放军总医院第五医学中心收治的43例接受根治性治疗的酒精相关性HCC患者临床资料,根据HDL-C水平分为正常组(n=26)及异常组(n=17)。比较2组间基本信息、实验室检验指标、影像学相关指标、肿瘤BCLC分期和肝功能Child-Pugh分级的差异。符合正态分布的计量资料2组间比较采用t检验,不符合正态分布的计量资料2组间比较采用Mann-Whithey U检验;计数资料2组间比较采用χ2检验。Kaplan-Meier法绘制生存曲线,组间比较采用log-rank检验。采用单因素和多因素Cox比例风险模型探索预后相关的独立危险因素。结果2组间前白蛋白比较差异有统计学意义[(162.38±60.86)mg/L vs(120.06±64.08)mg/L,t=2.184,P=0.035];肿瘤数目(HR=2.839,95%CI:1.120~7.200,P=0.028)、肿瘤大小(HR=2.634,95%CI:1.062~6.529,P=0.037)及HDL-C水平(HR=2.400,95%CI:1.040~5.537,P=0.040)是影响酒精相关性HCC患者总生存期的独立危险因素。HDL-C正常组的1、3、5年累积生存率分别为88.5%、72.4%、55.7%,HDL-C异常组分别为70.6%、43.7%、17.5%,2组累积生存率差异有统计学意义(χ2=5.881,P=0.015)。结论HDL-C水平的降低可能预示酒精相关性HCC患者预后较差。

Objective To investigate the association of high-density lipoprotein cholesterol(HDL-C)with the prognosis of patients with alcohol-related hepatocellular carcinoma(HCC)after radical treatment.Methods A retrospective analysis was performed for the clinical data of 43 patients with alcohol-related HCC who were admitted to The Fifth Medical Center of Chinese PLA General Hospital and underwent radical treatment from January 2008 to July 2015,and according to HDL-C level,the patients were divided into normal group with 26 patients and abnormal group with 17 patients.The two groups were compared in terms of basic information,laboratory markers,imaging indices,Barcelona Clinic Liver Cancer tumor stage,and Child-Pugh class of liver function.The t-test test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical data between two groups.The Kaplan-Meier method was used to plot survival curves and the log-rank test was used for comparison between groups.Univariate and multivariate Cox proportional hazards models were used to analyze independent risk factors for prognosis.Results There was a significant difference in prealbumin between the two groups(162.38±60.86 mg/L vs 120.06±64.08 mg/L,t=2.184,P=0.035).Number of tumors(hazard ratio[HR]=2.839,95%confidence interval[CI]:1.120~7.200,P=0.028),tumor size(HR=2.634,95%CI:1.062~6.529,P=0.037),and HDL-C level(HR=2.400,95%CI:1.040~5.537,P=0.040)were independent risk factors for the overall survival of patients with alcohol-related HCC.There were significant differences in 1-,3-,and 5-year cumulative survival rates between the normal group and the abnormal group(88.5%/72.4%/55.7%vs 70.6%/43.7%/17.5%,χ2=5.881,P=0.015).Conclusion The reduction in HDL-C level might indicate poor prognosis of patients with alcohol-related HCC.