术前天冬氨酸氨基转移酶与丙氨酸氨基转移酶比值对小肝癌患者术后早期复发的预测价值

Predictive value of preoperative aspartate aminotransferase to alanine aminotransferase ratio for early postoperative recurrence in patients with small hepatocellular carcinoma

目的探究术前天冬氨酸氨基转移酶与丙氨酸氨基转移酶比值(AAR)对单发小肝细胞癌根治性切除术后早期复发的预测价值。方法采用回顾性队列研究方法。回顾性分析2017年1月至2021年7月在宁夏医科大学总医院接受肝癌根治性切除术患者137例的临床资料。按照术后早期复发与否将其分为复发组(n=72)和非复发组(n=65)。通过训练队列中的单因素和多变量logistic回归分析确定了小肝癌早期复发的独立危险因素。将AAR进行分组,采用倾向性匹配(PSM)法将logistic模型估计的倾向性评分接近的患者按照1∶1配对,卡钳值0.02,消除混杂因素。再次应用logistic回归模型,分析匹配后AAR对小肝癌患者术后早期复发的预测价值。结果单因素分析显示,年龄(χ^(2)=4.22,P=0.040)、纤维蛋白原与白蛋白比值(χ^(2)=8.26,P=0.004)、AAR(χ^(2)=5.83,P=0.016)是小肝癌根治性术后早期复发的相关因素;多因素logistic回归分析显示,年龄(P=0.042)、纤维蛋白原与白蛋白比值(P=0.024)、AAR(P=0.018)为单发性小肝癌根治性术后早期复发的独立危险因素;经PSM法排除混杂因素,共25对患者匹配成功,匹配后,经logistic回归分析显示,AAR(>0.74)(P=0.005)、年龄(>60岁)(P=0.024)是单发性小肝癌根治性切除患者术后早期复发的独立危险因素。结论术前AAR是单发小肝癌患者术后早期复发的独立危险因素,具有良好的预测价值。

Objective To investigate the predictive value of preoperative aspartate aminotransferase to alanine aminotransferase ratio(AAR)for early recurrence after radical resection of single small hepatocellular carcinoma.Methods A retrospective cohort study was conducted to analyze the clinical data of 137 patients who underwent radical resection of liver cancer at the General Hospital of Ningxia Medical University from January 2017 to July 2021.These patients were categorized into a recurrence group(n=72)and a non-recurrence group(n=65)based on early postoperative recurrence.Univariate and multivariate logistic regression analyses were conducted in the training cohort to identify independent risk factors for early recurrence of small hepatocellular carcinomas.Subsequently,the AARs were grouped,and patients with similar propensity scores estimated by the logistic model were matched 1:1 using the Propensity Score Match method with a caliper value of 0.02 to eliminate confounders.Logistic regression analysis was then repeated to assess the predictive value of the matched AAR for postoperative recurrence in patients with single small hepatocellular carcinoma.Results Univariate analysis revealed that age(χ^(2)=4.22,P=0.040),the ratio of fibrinogen to albumin(χ^(2)=8.26,P=0.004),and the AAR(χ^(2)=5.83,P=0.016)were significantly associated with early recurrence of small liver cancer after radical resection.Multivariate logistic regression analysis further identified age(P=0.042),the ratio of fibrinogen to albumin(P=0.024),and the AAR(P=0.018)as independent risk factors for early recurrence of single small hepatocellular carcinoma following radical surgery.After excluding confounding factors using the Propensity Score Match method,25 patient pairs were successfully matched.Post-matching logistic regression analysis revealed that an AAR>0.74(P=0.005)and age>60 years(P=0.024)were independent risk factors for early recurrence in patients with single small hepatocellular carcinoma following radical resection.Conclusion Preoperative AAR is an independent risk factor for early recurrence in patients with single small hepatocellular carcinoma following surgery,demonstrating excellent predictive value.