白蛋白和凝血酶原时间比率对肝癌手术预后的预测价值

Predictive value of albumin and prothrombin time ratio for prognosis of hepatocellular carcinoma surgery

目的探讨肝癌患者行肝切除术前白蛋白和凝血酶原时间比率(APT)对预后的预测价值。方法选择2014年1月至2020年12月在广西医科大学第一附属医院治疗的272例经临床病理证实的肝细胞癌患者。建立ROC曲线,确定最佳截断值,将患者分为高低APT水平组,通过COX分析筛选肝癌患者的预测术后预后因素,K-M曲线分析APT对肝癌术后预后的影响。结果根据最佳截断值2.981,将APT分成高低水平组,曲线下面积为0.751(P<0.05)。总胆红素、凝血酶原时间(PT)、甲胎蛋白(AFP)等与APT水平分组均无明显相关(P>0.05),APT水平与肝癌患者预后呈正相关(P<0.05)。COX回归分析显示,总胆红素、AFP、肝硬化等与肝癌患者预后无关,而高低APT水平与肝癌预后相关[Exp(B)=4.32,95%CI:1.824~10.27,P=0.001]。结论APT是肝癌手术预后有效的预测指标。

Objective To investigate the prognostic value of albumin and prothrombin time ratio(APT)in hepatocellular carcinoma patients before hepatectomy.Methods 272 patients with hepatocellular carcinoma confirmed by clinical pathology were enrolled in the First Affiliated Hospital of Guangxi Medical University from January 2014 to December 2020.The ROC curve was established to determine the optimal cut-off value,and the patients were divided into high and low APT groups.COX analysis was used to screen the predictive factors for postoperative prognosis of patients with hepatocellular carcinoma,and the K-M curve was used to analyze the effect of APT on the prognosis of patients with hepatocellular carcinoma.Results The optimal cut-off value was 2.981.According to the optimal cut-off value,the APT was divided into high and low groups,with an area under the curve of 0.751(P<0.05).There was no significant correlation between total bilirubin,prothrombin time(PT),and AFP with the high and low APT groups(P>0.05).In addition,APT was positively correlated with the prognosis of patients with hepatocellular carcinoma(P<0.05);in COX regression analysis,total bilirubin,AFP,and liver cirrhosis were not related to the prognosis of patients with hepatocellular carcinoma,but high and low APT were related to the prognosis of patients with hepatocellular carcinoma(Exp(B)=4.32,95%CI 1.824-10.27,P=0.001).Conclusion APT is an effective predictor of the prognosis of patients with hepatocellular carcinoma after surgery.