NLR联合PLR评分与肝细胞癌肝移植预后的相关性研究

Combining neutrophil-lymphocyte ratio and platelet-lymphocyte ratio predicted the prognosis of hepatocellular carcinoma patients after liver transplantation

目的探讨中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)联合血小板/淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)评分对肝细胞癌肝移植受者预后的影响。方法回顾性分析2015年7月至2021年10月于河北医科大学第三医院因肝细胞癌行肝移植的110例受者的临床资料,计算术前最近一次的NLR、PLR,通过受试者工作特征曲线(ROC曲线)得到NLR、PLR截断值,并根据截断值进行分组,将NLR<3.37、PLR<105.96记为0分,NLR≥3.37、PLR≥105.96记为1分,两者相加为NLR-PLR评分,依据NLR-PLR评分将受者分为3组,即0分组、1分组、2分组,用Kaplan-Meier法分析受者生存时间,组间对比执行Log-rank检验,基于Cox比例风险回归模型进行单因素及多因素分析。结果NLR-PLR评分为0分者中位总生存时间(overall survival,OS)为27个月,1分者为26.5个月,2分者为6个月,NLR-PLR 2分者中位OS明显短于0分及1分者,差异有统计学意义(P<0.001),NLR-PLR 0分组中位无病生存时间(disease-free survival,DFS)为24.5个月,NLR-PLR 1分组中位DFS为24个月,NLR-PLR 2分组中位DFS为6个月,差异有统计学意义(P=0.002)。单因素分析显示Child-Pugh分级、终末期肝病模型(MELD)评分、NLR水平、PLR水平、NLR-PLR评分、是否符合美国加州大学旧金山分校标准(University of california san francisco criteria,UCSF)、是否有微血管侵犯(microvascular invason,MVI)对肝细胞癌肝移植受者的远期存活率有影响,进一步多因素分析显示NLR-PLR评分、是否符合UCSF标准、MELD评分是影响受者预后生存的独立危险因素。结论NLR、PLR、NLR-PLR评分可以预测受者远期生存状况,其中NLR-PLR评分是影响受者生存的独立危险因素,且较NLR、PLR更有预测价值。

Objective To explore the prognostic values of neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR)and NLR-PLR score for carcinoma(HCC)patients undergoing liver transplantation(LT).Methods From July 2015 to October 2021,clinical data are retrospectively reviewed for 110 HCC patients undergoing orthotopic LT at Third Hospital of Hebei Medical University.The values of NLR and PLR were calculated.And the cut-off values of NLR and PLR were obtained by receiver operating characteristic(ROC)curve and then grouped according to the cut-off values.Survival time is analyzed by Kaplan-Meier method and Log-rank test performed for inter-group comparison.Univariate and multivariate analyses are performed based on Cox proportional risk regression model.NLR<3.37 and PLR<105.96 are denoted as 0 point while NLR≥3.37 and PLR≥105.96 as 1 point.Two points are added up as NLR-PLR score.According to NLR-PLR score,they are divided into 3 groups of 0,1 and 2.Results Median overall survival(OS)is 27 months in patients with NLR-PLR score 0,26.5 months in patients with NLR-PLR score 1 and 6 months in patients with NLR-PLR score 2.Median OS in patients with NLR-PLR score 2 is significantly shorter than that in those with NLR-PLR score 0/1.And the difference is statistically significant(P<0.001).Median disease-free survival(DFS)is 24.5 months in NLR-PLR 0 group,24 months in NLR-PLR 1 group and 6 months in NLR-PLR 2 group.The difference is statistically significant(P=0.002).Univariate analysis show that Child-Pugh grade,MELD score,NLR/PLR level,NLR-PLR score,complying with University of California San Francisco Criteria(UCSF)criteria and absence/presence of microvascular invasion(MVI)have an impact on patient survival.Further multivariate analysis show that NLR-PLR score,complying with UCSF criteria and MELD score are independent risk factors affecting patients'prognosis and survival.Conclusions NLR,PLR and NLR-PLR score may predict long-term survival of patients.And NLR-PLR score is an independent risk factor for patient survival.It has more predictive value than NLR/PLR.