术前碱性磷酸酶与前白蛋白比值对肝细胞癌切除术后总体生存期的影响

Effect of preoperative alkaline phosphatase to prealbumin ratio on overall survival after hepatectomy

目的探讨术前碱性磷酸酶和前白蛋白比值(alkaline phosphatase to prealbumin ratio,APR)对肝细胞癌(hepatocellular carcinoma,HCC)患者肝切除术后总生存期(overall survival,OS)的影响。方法回顾性分析2012年1月至2016年12月广西医科大学附属肿瘤医院收治的942例接受肝切除术的HCC患者的临床资料。采用时间依赖的受试者工作特征(receiver operating characteristic,ROC)曲线确定APR的cut‐off值,并根据cut‐off值将患者分为高APR组(APR≥cutoff值)和低APR组(APR<cut‐off值)。采用Kaplan‐Meier法绘制不同APR组的生存曲线,并采用log‐rank检验进行比较。采用时间依赖的Cox比例风险回归模型分析HCC患者肝切除术后OS的影响因素。结果通过ROC曲线可知APR预测HCC患者术后5年预后结局的ROC曲线下面积(area under the curve,AUC)为0.656,APR的cut‐off值为0.38 U/mg。低APR组术后1、3、5年总体生存率分别为90.3%、75.5%和69.5%,高APR组分别为76.5%、54.5%和46.0%,两组比较差异有统计学意义(P<0.001)。多因素Cox比例风险回归模型分析结果显示,高APR是影响HCC患者肝切除术后OS的独立危险因素(HR=1.646,95%CI:1.323~2.047,P<0.001)。结论术前高APR是HCC患者肝切除术后预后的独立危险因素,可能作为HCC患者肝切除术后不良预后的预测因子。

Objective To investigate the effect of preoperative alkaline phosphatase to prealbumin ratio(APR)on overall survival(OS)of hepatocellular carcinoma(HCC)patients after hepatectomy.Methods The clinical data of 942 HCC patients who underwent hepatectomy in the Guangxi Medical University Cancer Hospital from January 2012 to December 2016 were retrospectively analyzed.The cut‐off value of APR was determined by time‐dependent receiver operating characteristic(ROC)curve.According to the cut‐off value,patients were divided into high APR group(APR≥cut‐off value)and low APR group(APR<cut‐off value).Survival curves of different APR groups were plotted by Kaplan‐Meier method and compared by log‐rank.Cox proportional risk regression model was used to analyze the factors affecting OS after hepatectomy in HCC patients.Results The ROC curves showed that the area under the curve(AUC)of APR for predicting the prognosis of HCC patients at 5 years after surgery was 0.656,and the cut‐off value of APR was 0.38 U/mg.The 1‐,3‐,and 5‐year overall survival rates of the low APR group were 90.3%,75.5%,and 69.5%,respectively,and those of the high APR group were 76.5%,54.5%,and 46.0%,respectively,the difference between the two groups was statistically significant(P<0.001).Multivariable Cox proportional hazards regression model analysis showed that high APR was an independent risk factor for OS in HCC patients after hepatectomy(HR=1.646,95%CI:1.323-2.047,P<0.001).Conclusions Preoperative high APR is an independent risk factor for prognosis of HCC patients after hepatectomy,and may be a predictor of poor prognosis in HCC patients after hepatectomy.