外周血中性粒细胞-淋巴细胞比值、血小板-淋巴细胞比值对不可切除肝细胞癌经导管动脉化疗栓塞和靶向免疫治疗疗效及预后的预测价值

Prognostic value of peripheral blood neutrophil to lymphocytes ratio and platelet to lymphocyte ratio in the combined treatment of unresectable hepatocellular carcinoma through transcatheter arterial chemoembolization+targeted immunotherapy

目的探讨外周血中性粒细胞-淋巴细胞比值(NLR)、血小板-淋巴细胞比值(PLR)基线值及其动态变化对接受经导管动脉化疗栓塞(TACE)加仑伐替尼及卡瑞利珠单抗治疗的肝细胞癌(HCC)患者疗效及预后的预测价值。方法回顾性分析2020年1月至2023年2月蚌埠医学院第一附属医院收治的119例接受TACE加仑伐替尼及卡瑞利珠单抗三联疗法的HCC患者的临床资料,统计治疗前及治疗2个月时的NLR、PLR值分别记作NLR_(0)、PLR_(0)和NLR_(2)、PLR_(2),根据临床疗效评价是否有效将所有患者分为有效组和无效组,比较两组的NLR_(0)、PLR_(0)和NLR_(2)、PLR_(2),根据受试者工作特征(ROC)曲线得出NLR、PLR的最佳截断值,将NLR、PLR分成高、低2组,进行KaplanMeier生存分析,单因素及多因素回归分析采用Cox比例风险模型。结果根据ROC确定NLR_(0)、PLR_(0)和NLR_(2)、PLR_(2)的最佳截断值为2.1、134.4和2.8、153.0。有效组NLR_(2)和PLR_(2)水平均明显低于无效组(均P<0.01)。单因素及多因素分析表明,NLR_(2)、PLR_(0)、年龄与总生存期相关(均P<0.05)。动态分析发现,低PLR_(0)、低PLR_(2)组的中位生存期为29个月,显著优于高PLR_(0)、高PLR_(2)组的14个月(P<0.001);低NLR_(0)、低NLR_(2)组的中位生存期为26.5个月,优于高NLR_(0)、高NLR_(2)组的18.1个月(P=0.002)。结论外周血NLR、PLR的基线值及动态变化对接受TACE加仑伐替尼及卡瑞利珠单抗的患者疗效及预后均有一定预测价值。

Objective To investigate the value of baseline and dynamic changes of peripheral blood neutrophil to lymphocyte ratio(PLR)and platelet to lymphocyte ratio(PLR)in predicting the curative effect and prognosis of patients with hepatocellular carcinoma(HCC)treated with transcatheter arterial chemoembolization(TACE)+Lenvatinib+camrelizumab.Methods The clinical data of 119 HCC patients admitted to the First Affiliated Hospital of Bengbu Medical College from January 2020 to February 2023 who received triple therapy of TACE+Lenvatinib+camrelizumab were retrospectively analyzed.The levels of NLR and PLR before treatment and two months after treatment were recorded as NLR_(0),PLR_(0),NLR_(2) and PLR_(2),respectively.The levels of NLR_(0),PLR_(0) and NLR_(2),PLR_(2) in the effective group and the ineffective group were compared.According to receiver operating characteristic(ROC)curve,the optimal cut-off values of NLR and PLR were obtained,and used as the basis for grouping high and low.Kaplan-Meier method was used for survival analysis,and Cox proportional risk model was used for univariate and multivariate regression analysis.Results According to ROC,the best cut-off points of NLR_(0),PLR_(0) and NLR_(2),PLR_(2) were 2.10,134.4 and 2.8,153.0.The levels of NLR_(2) and PLR_(2) in the effective group were significantly lower than those in the ineffective group(P<0.01).Univariate and multivariate analysis showed that NLR_(2),PLR_(0),and age were correlated with overall survival(all P<0.05).Dynamic analysis revealed that the median survival time of the low PLR_(0) and low PLR_(2) groups was 29 months,significantly better than the 14 months of the high PLR_(0) and high PLR_(2) groups(P<0.001);the median survival time of the low NLR_(0) and low NLR_(2) groups was 26.5 months,which was better than the 18.1 months of the high NLR_(0) and high NLR_(2) groups(P=0.002).Conclusion The baseline values and dynamic changes of peripheral blood NLR and PLR can predict the efficacy and prognosis of patients receiving TACE+Lenvatinib+Camrelizumab.