以血小板为基础的无创预测模型在肝细胞肝癌预后中的应用价值研究

The value of platelet-based non-invasive prediction model in the prognosis of hepatocellular carcinoma

目的探讨以血小板为基础的术前外周血肝纤维化诊断模型在肝细胞肝癌根治性切除术后病人预后中的应用价值。方法回顾性分析2009年1月至2018年06月蚌埠医学院第一附属医院肝胆外科接受根治性治疗的肝细胞肝癌的病人临床病理资料,共485例。采用ROC曲线天门冬氨酸转移酶/血小板比值(APRI)、基于4因子的纤维化指数(Fib4)、γ-谷氨酰基转移酶/血小板比值(CPR)的最佳截断值,参照国际通用标准对血小板-白蛋白-胆红素比值(PALBI)进行分组。采用Kaplan-Meier法、Log-rank检验、Cox比例风险回归模型进行相应单因素及多因素生存分析比较,各预后模型的预后价值评定采用一致性指数(C-index)评价。结果单因素分析表明,APRI、Fib4、GPR、PALBI是影响肝细胞肝癌根治性切除术病人预后的危险因素;多因素分析发现,PALBI、Fib4是OS和RFS的独立预测因素,GPR是OS的独立预测因素,但对预后的预测效能较低,联合肿瘤直径及甲胎蛋白水平后,C-index显示出较高的预测生存能力。结论以血小板为基础的APRI、Fib4、GPR及PALBI外周血肝纤维化指标,特别是与肿瘤大小及甲胎蛋白水平相结合后,是鉴别肝细胞肝癌根治性术后有效预后模型。

Objective To investigate the application value of platelet-based preoperative peripheral blood for liver fibrosis diagnostic model in prognosis of patients after radical resection of hepatocellular carcinoma(HCC).Methods The clinicopathological data of 485 patients with hepatocellular carcinoma who received radical treatment in the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Bengbu Medical College from January 2009 to June 2018 were retrospectively analyzed.The best cut-off values of aspartate transferase/platelet ratio(APRI),the 4-factor-based fibrosis index(Fib4),and the-glutamyltransferase/platelet ratio(GPR)of the ROC curve were used,referring to the international standard The platelet-albumin-bilirubin ratio(PALBI)was grouped.The Kaplan-Meier method,the log-rank test,and the Cox proportional hazards regression model were used to compare the corresponding univariate and multivariate survival analyses,and the prognostic value of each prognostic model was estimated by the consistency index(C-index)rated.Results Univariate analysis showed that APRI,Fib4,GPR and PALBI were risk factors affecting prognosis in patients with hepatocellular carcinoma who underwent radical resection.Multivariate analysis found that PALBI and Fib4 were independent predictors of OS and RFS,and GPR was an independent predictor of OS.predictive factor,but the predictive power of the forecast was low.In combination with tumor diameter and alpha-fetoprotein levels,the C-index showed a higher predictive ability for survival.Conclusion Platelet-based APRI,Fib4,GPR and PALBI indicators of peripheral blood liver fibrosis,especially when combined with tumor size and alpha-fetoprotein level,are effective prognostic models for identifying hepatocellular carcinoma after radical surgery.