术前血清铁蛋白、白蛋白、铁蛋白与白蛋白比值与肝细胞癌患者肝切除术预后的关系

Relationships of preoperative serum ferritin, albumin and ratio of ferritin to albumin with prognosis after hepatectomy in patients with hepatocellular carcinoma

目的 探讨术前血清铁蛋白、白蛋白、铁蛋白与白蛋白比值与肝细胞癌患者肝切除术预后的关系。方法 回顾性分析2015年1月—2020年1月行肝切除术治疗的112例肝细胞癌患者的临床资料。采用受试者工作特征(ROC)曲线分析血清铁蛋白、白蛋白、铁蛋白与白蛋白比值预测不良预后的最佳临界值。根据临界值对患者进行分类,分析不同血清铁蛋白、白蛋白、铁蛋白与白蛋白比值与临床病理特征的关系。采用多因素Cox比例风险回归分析影响预后的相关因素。结果 112例患者总生存期为5~75个月,平均(53.84±6.51)个月;对于铁蛋白≥108.63μg/L、白蛋白≤41.19 g/L、铁蛋白与白蛋白比值≥3.42的患者,其生存期为5~31个月,平均(28.56±3.12)个月;对于铁蛋白<108.63μg/L、白蛋白>41.19 g/L、铁蛋白与白蛋白比值<3.42的患者,其生存期为12~75个月,平均(72.11±1.25)个月;上述差异有统计学意义(t=101.924,P<0.001)。术前血清铁蛋白、白蛋白、铁蛋白与白蛋白比值与肝硬化有相关性(P<0.05)。多因素Cox比例风险回归分析结果显示,血清铁蛋白≥108.63μg/L、白蛋白≤41.19 g/L、铁蛋白与白蛋白比值≥3.42、有肝硬化是肝细胞癌患者肝切除术后预后不良的影响因素。结论 术前血清铁蛋白≥108.63μg/L、白蛋白≤41.19 g/L、铁蛋白与白蛋白比值≥3.42是肝细胞癌患者肝切除术预后的独立危险因素,术前血清铁蛋白、铁蛋白与白蛋白比值升高以及白蛋白水平降低提示预后不良。

Objective To explore the relationships of preoperative serum ferritin, albumin and ratio of ferritin to albumin with prognosis after hepatectomy in patients with hepatocellular carcinoma.Methods Clinical materials of 112 patients with hepatocellular carcinoma treated by hepatectomy from January 2015 to January 2020 were retrospectively analyzed.The optimal critical value of serum ferritin, albumin and the ratio of ferritin to albumin in predicting poor prognosis was analyzed by receiver operating characteristic(ROC) curve.The patients were classified according to the critical value, and the relationships of different serum ferritin, albumin, and ratio of ferritin to albumin ratio with clinicopathological features were analyzed.Multivariate Cox proportional hazards regression was used to analyze the related factors affecting the prognosis.Results The overall survival of 112 patients was 5 to 75 months, with an average of(53.84±6.51) months;for patients with ferritin≥108.63 μg/L, albumin≤41.19 g/L and the ratio of ferritin to albumin≥3.42, their survival was 5 to 31 months, with an average of(28.56±3.12) months;for patients with ferritin<108.63 μg/L, albumin>41.19 g/L and ratio of ferritin to albumin<3.42, their survival was 12 to 75 months, with an average of(72.11±1.25) months;the differences mentioned above were statistically significant(t=101.924, P<0.001).Preoperative serum ferritin, albumin and the ratio of ferritin to albumin were correlated with liver cirrhosis(P<0.05).Multivariate Cox proportional hazards regression analysis showed that serum ferritin ≥108.63 μg/L, albumin≤41.19 g/L, the ratio of ferritin to albumin≥3.42 and cirrhosis were the influencing factors of poor prognosis after hepatectomy in patients with hepatocellular carcinoma.Conclusion Preoperative serum ferritin ≥108.63 μg/L, albumin ≤41.19 g/L and ratio of ferritin to albumin≥3.42 are the independent risk factors for the prognosis of patients with hepatocellular carcinoma after hepatectomy, and the increase of serum ferritin and ratio of ferritin to albumin as well as the decrease of albumin level before hepatectomy suggest poor prognosis.