中性粒细胞与淋巴细胞比值联合系统免疫炎症指数评价乙肝相关肝细胞癌切除术后预后的价值

The value of neutrophil to lymphocyte ratio combined with systemic immune inflammation index in evaluating the prognosis of hepatitis B-related hepatocellular carcinoma after hepatectomy

目的探讨中性粒细胞与淋巴细胞比值(NLR)和系统免疫炎症指数(SⅡ)联合应用对乙肝相关肝细胞癌切除术后预后的预测价值。方法回顾性收集2013年1月至2019年12月期间在西南医科大学附属医院传染病科及肝胆外科住院并接受手术治疗的180例乙肝相关肝细胞癌患者的资料,包括:一般资料,血常规如中性粒细胞数、淋巴细胞数等,凝血指标如血小板计数(PLT),肿瘤标志物如甲胎蛋白(AFP),腹部CT或MRI等相关影像学检查结果,并计算NLR和SⅡ值,通过受试者工作特征曲线分析确定NLR和SⅡ预测乙肝相关肝细胞癌切除术后预后的最佳临界值,并分析其高低情况对生存情况的影响,同时采用单因素和多因素Cox比例风险回归分析影响预后的危险因素。结果单因素分析结果显示:AFP、PLT、TNM分期、门静脉癌栓、肿瘤分化程度、NLR、SⅡ以及NLR+SⅡ联合评分与乙肝相关肝细胞癌患者的预后具有相关性(P<0.05)。多因素分析结果显示:PLT [HR=1.791,95%CI为(1.124,2.854),P=0.014]、NLR [HR=4.289,95%CI为(2.571,7.156),P<0.001]、SⅡ[HR=5.317,95%CI为(3.016,9.374),P<0.001]以及NLR+SⅡ联合评分[HR=7.901,95%CI为(4.124,15.138),P<0.001]与乙肝相关肝细胞癌患者的生存独立相关。结论患者术前NLR+SⅡ联合评分可用于评估乙肝相关肝细胞癌切除术后患者的预后,评分越高,术后生存率越低。

Objective To explore the combined application of neutrophil to lymphocyte ratio(NLR)and systemic immune inflammation index(SⅡ)on the prognosis of hepatitis B-related hepatocellular carcinoma after resection.Methods Retrospectively collected data of 180 patients with hepatitis B-related hepatocellular carcinoma who were hospitalized in the Department of Infectious Diseases and Hepatobiliary Surgery of the Affiliated Hospital of Southwest Medical University and received surgical treatment from January 2013 to December 2019,including general information,laboratory examination and abdominal CT or MRI results.NLR and SⅡvalues were measured at one week before operation,and their critical values of NLR and SⅡwere determined by ROC curve analysis.Univariate and multivariate analysis were performed to determine the risk factors to predict the survival status of patients with hepatitis B-related hepatocellular carcinoma after hepatectomy.Results Univariate analysis showed that AFP,platelets,TNM staging,portal vein tumor thrombus,tumor differentiation,NLR,SⅡ,and NLR+SⅡcombined score were significantly correlated with the prognosis of patients with hepatitis B-related hepatocellular carcinoma(P<0.05).Multivariate analysis showed that PLT[HR=1.791,95%CI(1.124,2.854),P=0.014],NLR[HR=4.289,95%CI(2.571,7.156),P<0.001],SⅡ[HR=5.317,95%CI(3.016,9.374),P<0.001],and NLR+SⅡcombined score[HR=7.901,95%CI(4.124,15.138),P<0.001]were independently correlated with the survival of patients with hepatitis B-related hepatocellular carcinoma.Conclusions The preoperative NLR+SⅡcombined score can be used to evaluate the postoperative prognosis of patients with hepatitis B-related hepatocellular carcinoma.The higher the score,the lower the postoperative survival rate.