术前血清胱抑素C对乙型肝炎病毒相关性肝细胞癌患者预后的影响

Effect of preoperative serum cystatin C level on prognosis of patients with Hepatitis B virus-associated hepatocellular carcinoma

目的探讨术前血清胱抑素C水平(Cys-C)对行肝癌切除术后乙型肝炎病毒相关性肝细胞癌(HBV-HCC)患者预后的影响。方法收集2014年1月至2019年6月于广西医科大学附属肿瘤医院住院行肝癌切除术的940例HBV-HCC患者的临床和随访资料。根据surv_cutpoint函数确定术前HBV-HCC患者血清Cys-C水平的最佳临界值,将所有患者进行分组。运用单因素和多因素Cox回归模型分析影响总生存期(OS)的独立危险因素。结果HBV-HCC患者术前血清Cys-C水平的最佳临界值为0.710 mg/L。高血清Cys-C水平组患者中男性、年龄≥50岁和有吸烟史者的比例分别高于低血清Cys-C水平组患者[男性:高水平组(88.5%,753例)比低水平组(69.7%,62例),χ^(2)=23.150,P<0.001;年龄≥50岁:高水平组(55.3%,471例)比低水平组(30.3%,27例),χ^(2)=19.239,P<0.001;有吸烟史:高水平组(42.5%,362例)比低水平组(23.6%,21例),χ^(2)=11.203,P<0.001]。对巴塞罗那分期、Child分级和甲胎蛋白等因素进行校正后,多因素Cox回归分析结果发现血清Cys-C水平是HBV-HCC患者术后OS的独立影响因素,高血清Cys-C水平组患者行肝癌切除术后的死亡风险显著高于低血清Cys-C水平组(高水平组比低水平组,风险比=1.823,95%可信区间=1.143~2.910,P<0.05)。结论术前血清Cys-C水平升高是HBV-HCC患者行肝癌切除术后预后的独立危险因素。

Objective To investigate the effect of preoperative serum cystatin C level(Cys-C)on the prognosis of patients with hepatitis B virus associated hepatocellular carcinoma(HBV-HCC)after hepatectomy.Methods The clinical data and follow-up data of 940 patients with HBV-HCC after hepatectomy at the Guangxi Medical University Cancer Hospital from January 2014 to June 2019 were collected.According to surv_cutpoint,the optimal critical value of serum Cys-C level in HBV-HCC patients was determined,and all patients were divided into two groups.Univariate and multivariate Cox regression models were used to analyze independent risk factors affecting overall survival(OS).Results The optimal cut-off value of preoperative serum Cys-C level in HBV-HCC patients was 0.710 mg/L.The proportion of male,age≥50 years and ever smoking in the high Cys-C level group were higher than those in the low serum Cys-C level group[male:high level group(88.5%,753 cases)vs.low level group(69.7%,62 cases),χ^(2)=23.150,P<0.001;age≥50 years old:the high level group(55.3%,471 cases)vs.the low level group(30.3%,27 cases),χ^(2)=19.239,P<0.001;ever smoking:high level group(42.5%,362 cases)vs.low level group(23.6%,21 cases),χ^(2)=11.203,P<0.001].After adjusting for Barcelona Clinic Liver Cancer(BCLC)stage,Child grade and alpha-fetoprotein(AFP),the result of multivariate Cox regression analysis showed that serum Cys-C level was an independent risk factor for HBV-HCC patients.The risk of death after hepatectomy was significantly higher in the high serum Cys-C group than in the low serum Cys-C group(high level group vs.low level group,Hazard ratio=1.823,95%Confidence interval=1.143-2.910,P<0.05).Conclusion Higher preoperative serum Cys-C level is an independent risk factor for HBV-HCC patients prognosis after hepatectomy.