中性粒细胞淋巴细胞比值联合患病年龄在双表型肝细胞癌诊断中的应用价值

Application value of neutrophil lymphocyte ratio combined with age in the diagnosis of dual-phenotype hepatocellular carcinoma

目的了解中性粒细胞淋巴细胞比值联合患病年龄在同时期双表型肝细胞癌(DPHCC)患者与非双表型肝细胞癌(非DPHCC)患者中临床诊断价值,以寻求快捷有效的鉴别诊断生物标志物。方法回顾性分析2017年5月至2020年5月南通大学附属医院行根治性肝癌切除术的患者164例,其中DPHCC共29例(17.7%),非DPHCC共135例(82.3%)。统计以上患者临床病历资料,包括患者基本信息、临床症状体征、传染病史、术前1 d实验室化验指标、术后病理报告等相关资料,术后随访时间18个月,资料完整。通过分析同时期DPHCC患者与非DPHCC患者的临床病历资料,以寻找快捷有效的鉴别诊断指标物,并探讨提示DPHCC患者预后不良的指标。结果单因素方差分析显示,DPHCC和非DPHCC组患者患病年龄[(53.9±10.0)与(62.6±9.1)岁]、甲胎蛋白[143(4.8~984.8)与9.9(2.8~71.3)μg/L]、中性粒细胞淋巴细胞比值(NLR)(3.650±1.924与2.220±1.486)、中性粒细胞数、淋巴细胞数、脉管浸润率、TNM分期、中国肝癌分期(CNLC)、Child分级和日本综合分期评分(JIS)等方面差异均有统计学意义(均P<0.05)。多因素logistic回归分析确定患病年龄(OR值:0.967,95%CI:0.860~0.957)和NLR(OR值:1.564,95%CI:1.205~2.029)为DPHCC鉴别诊断的危险因素。利用受试者工作特征(ROC)曲线评价后发现NLR的诊断效能最大,最佳截断值为2.586。其联合患病年龄可提高鉴别诊断能效性,最大的诊断效能为曲线下面积(AUC)=0.836,灵敏度为89.66%,特异度为65.93%。结论NLR联合患病年龄对预测DPHCC具有一定的可行性,或可成为鉴别DPHCC与非DPHCC患者的有效指标。

Objective This study retrospectively analyzed the clinical medical records of patients with dual phenotypic liver cancer(DPHCC)and those(non-DPHCC)in the same period to seek quick and effective biomarkers for differential diagnosis.Methods A retrospective study was conducted on 164 patients who underwent radical hepatocellular carcinoma resection at Affiliated Hospital of Nantong University from May 2017 to May 2020,including 29 patients with DPHCC,accounting for 17.7%(age:53.9±10.0).There were 135 non-DPHCC patients,accounting for 82.3%(age,62.6±9.1).The clinical records of the above patients were collected,including the basic information of the patients,clinical symptoms and signs,history of infection,laboratory test indexes one day before surgery,postoperative pathological report and other relevant data,The follow-up time was 18 months and the data were complete.By analyzing the clinical data of DPHCC patients and non-DPHCC patients in the same period,to find quick and effective differential diagnostic indicators,and to explore the indicators indicating poor prognosis of DPHCC patients.Results One-way ANOVA showed significant differences in age,AFP[143(4.8-984.8)vs 9.9(2.8-71.3)μg/L],NLR(3.650±1.924 vs 2.220±1.486),neutrophil count,lymphocyte count,vascular infiltration rate,TNM stage,Chinese Hepatocellular carcinoma Staging(CNLC),Child grade,and Japanese General Staging Score(JIS)(P<0.05).Multivariate logistic regression analysis identified age(OR score:0.967,95%CI:0.860-0.957)and NLR(OR score:1.564,95%CI:1.205-2.029)as independent risk factors for DPHCC differential diagnosis.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficiency of NLR,and the best cut-off value was 2.586.The combination of age at onset improved the efficiency of differential diagnosis.When reaching the maximum diagnostic efficiency,the area under curve(AUC)was 0.836,the sensitivity was 89.66%,and the specificity was 65.93%.Conclusion NLR combined with the age of disease has certain feasibility in predicting DPHCC and may be an effective index to distinguish DPHCC from non-DPHCC patients.