术前碱性磷酸酶-前白蛋白比值对肝细胞癌切除术预后的评估价值

Preoperative alkaline phosphatase to prealbumin ratio predicting the prognosis of hepatocellular carcinoma after hepatectomy

目的探讨术前碱性磷酸酶-前白蛋白比值(APR)对根治性手术切除的肝细胞癌(HCC)患者预后的评估价值,以指导临床预后。方法回顾性分析2012年4月至2019年11月在中国医科大学附属盛京医院行根治性手术切除的184例HCC患者的临床资料。用U检验比较分析连续变量,卡方检验及秩和检验比较分析分类变量;限制性立方样条检验APR与预后结局是否线性相关,用X-tile软件获取APR最佳cut-off值;Kaplan-Meier生存分析绘制生存曲线并进行对数秩检验比较,并以Cox比例风险回归模型进行单因素及多因素分析。结果限制性立方样条结果显示,APR与无复发生存时间(RFS)、总生存时间(OS)两个预后结局均为线性相关,以APR最佳cut-off值分为APR≤628.38组131例,APR>628.38组53例。两组患者的性别、Child-Pugh分级、肿瘤大小以及术中输血情况差异有统计学意义(P<0.05),术后中位RFS分别为43个月和22个月、中位OS分别为未达到和48个月,差异均有统计学意义(均P<0.01)。单因素分析和Cox多因素分析显示,APR>628.38和肿瘤大小>5 cm是患者RFS的独立危险因素(P<0.01),APR>628.38和甲胎蛋白>400μg/L是患者OS的独立危险因素(P=0.001)。简化评分结果显示,APR≤628.38的患者中74.05%为RFS低风险,77.10%为OS低风险;APR>628.38的患者均为RFS、OS高风险。结论APR对患者整体预后的影响较大,术前APR>628.38是HCC患者根治性切除术后RFS和OS的独立危险因素,对HCC患者的预后有较好的预测价值。

Objective To evaluate the ability of preoperative alkaline phosphatase to prealbumin ratio(APR)as a predictive factor for the prognosis of hepatocellular carcinoma(HCC),and to guide the clinical prognosis evaluation.Methods A total of 184 HCC patients who underwent radical surgical treatment in Shengjing Hospital of China Medical University from April 2012 to November 2019 were retrospectively analyzed.Non-parametric Mann-Whitney U test,Chi-square test,and rank-sum test were used for comparison.Restricted cubic spline(RCS)was used for checking whether APR was linearly related to the prognoses.The best cut-off value was obtained by X-tile software.Kaplan-Meier curve and Log-rank test was used for the survival analysis.A multiple Cox regression model was set for univariate analysis and multiple analysis.Results The result of RCS showed that APR was linear correlation with both prognoses.The best cut-off value of APR was 628.38.According to the cut-off value,the patients were divided into the APR≤628.38 group(131 cases)and the APR>628.38 group(53 cases).There were signifi cant differences in gender,Child-Pugh,tumor size,and transfusion between the two groups(P<0.05),the median recurrence free survival(RFS)was 43 months in the APR≤628.38 group and 22 months in the APR>628.38 group respectively,and the median overall survival(OS)was not achieved in the APR≤628.38 group and 48 months in the APR>628.38 group respectively,with statistically signifi cant differences(P<0.01).Univariate analysis and Cox multivariate analysis suggested that APR>628.38 and tumor size>5 cm were independent variables of RFS(P<0.01).Analogously,APR>628.38 and alpha fetoprotein>400μg/L were independent predictors of OS(P=0.001).The results of simplifi ed score showed that for patients with APR≤628.38,74.05%were low-risk population of RFS and 77.10%were low-risk population of OS,and that patients with APR>628.38 were all at high risk RFS and OS.Conclusion Preoperation APR has a good predictive value for the prognosis of HCC patients,and APR>628.38 is an independent risk factor for the RFS and OS of patients.