γ-谷氨酰转移酶与前白蛋白比值对肝细胞癌根治性切除术后患者的预后预测价值:历史性队列研究

Prognostic prediction value of gamma-glutamyltransferase-to-prealbumin ratio for patients with hepatocellular carcinoma after radical resection:a historical cohort analysis

目的探讨血清γ-谷氨酰转移酶与前白蛋白比值(gamma-glutamyltransferase-to-prealbumin ratio,GPR)对肝细胞癌(hepatocellular carcinoma,HCC)根治性切除术后患者的预后预测价值。方法回顾性收集2013年1月至2021年11月期间西南医科大学附属医院收治的行根治性手术且符合纳入标准的HCC患者。通过受试者操作特征(receiver operating characteristic,ROC)曲线确定GPR预测HCC患者总生存期的最佳临界值,根据最佳临界值将患者分为低GPR组(GPR≤最佳临界值)和高GPR组(GPR>最佳临界值),比较2组患者临床病理特征的差异。采用Kaplan-Meier法绘制生存曲线进行生存分析并采用log-rank检验对2组间生存情况(总生存期和无复发生存期)进行比较。通过单因素和多因素Cox回归分析影响HCC患者术后总生存期和无复发生存期的风险因素,同时采用ROC曲线评估GPR对HCC患者总生存期的预测价值。结果共收集到符合纳入条件的HCC患者216例。通过ROC曲线分析得到GPR的最佳临界值为0.29,低GPR组和高GPR组分别为93例和123例。与低GPR组比较,高GPR组中术前丙氨酸氨基转移酶>50 U/L、白蛋白<40 g/L、总胆红素≥34.2μmol/L、肿瘤直径>5 cm、肿瘤多病灶、中国肝癌分期方案(China liver cancer staging,CNLC)分期Ⅲ期以及手术类型为大范围肝切除术(切除≥3个肝段)的患者占比更高(P<0.05)。Kaplan-Meier生存曲线结果显示,低GPR组的总生存和无复发生存情况均优于高GPR组(χ2=14.356、P<0.001;χ2=7.963、P=0.005)。Cox回归多因素分析结果显示,术前甲胎蛋白≥400μg/L、GPR>0.29、CNLC分期Ⅲ期和手术时间超过3 h是HCC患者总生存期和无复发生存期缩短的风险因素(P<0.05)。单独GPR及它分别联合风险因素(术前甲胎蛋白和CNLC分期)以及这三者联合预测HCC患者总生存期的ROC曲线下面积分别为0.636、0.712、0.696和0.737。结论从本研究结果看,GPR与HCC患者生存有关,并且它同时联合术前甲胎蛋白和CNLC分期对总生存期预测有一定价值。

Objective To research prognostic prediction value of serumγ-glutamyltransferase-to-prealbumin ratio(GPR)for patients with hepatocellular carcinoma(HCC)after radical resection.Methods The clinical data of HCC patients undergoing radical resection from January 2013 to November 2021 were analyzed retrospectively.The optimal critical value of GPR was determined by receiver operating characteristic(ROC)curve.The patients were allocated into the low GPR group(GPR was the optimal critical value or less)and the high GPR group(GPR was greater than the optimal critical value).The differences of clinicopathologic characteristics were compared between the two groups.The overall survival(OS)and relapse-free survival(RFS)were analyzed by the Kaplan-Meier survival curve and compared by the log-rank test between the two groups.The risk factors affecting the OS and RFS of patients with HCC were analyzed by univariate and multivariate Cox regression,and the predictive value of GPR on the OS was evaluated by ROC curve.Results A total of 216 eligible HCC patients were gathered.The optimal critical value of GPR was 0.29,93 cases were in the low GPR group and 123 cases were in the high GPR group.Compared with the low GPR group,the proportions of the patients with preoperative alanine aminotransferase>50 U/L,albumin<40 g/L,total bilirubin≥34.2μmol/L,tumor size>5 cm,multiple tumor lesions,stageⅢof China liver cancer staging(CNLC),and major hepatectomy(liver segment resection was 3 or more)were higher in the high GPR group(P<0.05).The Kaplan-Meier survival curve showed that the OS and RFS of the low GPR group were better than those of the high GPR group(χ2=14.356,P<0.001;χ2=7.963,P=0.005).Cox regression multivariate analysis showed that the preoperative alpha-fetoprotein(AFP)≥400μg/L,GPR>0.29,stageⅢof CNLC,and operation time(more than 3 h)were the risk factors for OS and RFS of HCC patients(P<0.05).The area under the ROC curve of GPR alone and it in combination with risk factors(preoperative AFP and CNLC stage,respectively)and in combination with the above three indicators to predict the OS of patients with HCC were 0.636,0.712,0.696,and 0.737,respectively.Conclusion From the results of this study,GPR is associated with the postoperative survival of patients with HCC after radical resection,and GPR in combination with preoperative AFP and CNLC stage has a certain predictive value for the OS.