炎症负荷指数预测混合型肝细胞癌-胆管癌患者预后的临床意义

Clinical significance of inflammatory burden index in predicting prognosis of patients with mixed hepatocellular carcinoma and cholangiocarcinoma

目的探讨炎症负荷指数(IBI)预测混合型肝细胞癌-胆管癌(cHCC-CCA)患者预后的临床意义。方法回顾性分析2019年1月至2023年2月在南京医科大学附属江宁医院接受肝切除术后经病理组织学确诊的106例cHCC-CCA患者。采集患者术前1天全血,计算中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、单核细胞与淋巴细胞比值(MLR)、炎症负荷指数(IBI)、全身免疫炎症指数(SII)。随访患者的总生存期(OS)和无病生存期(DFS)。Kaplan-Meier法绘制生存曲线,生存差异行Log-rank检验。采用Cox风险比例回归模型分析影响患者DFS和OS的因素。结果IBI预测cHCC-CCA患者死亡风险的曲线下面积(AUC)为0.822(95%CI:0.731~0.912),最佳截断值为101.03。根据截断值,将患者分为低IBI组(<101.03)和高IBI组(≥101.03)。IBI与cHCC-CCA患者T分期、AJCC分期和组织学分级有关(P<0.05),而与其他临床病理特征无关(P>0.05)。高IBI组患者中位DFS和中位OS分别为16个月和24个月,均显著低于低IBI组的54个月和40个月,差异有统计学意义(P<0.05)。多因素Cox风险比例回归模型显示,淋巴血管侵犯、AJCC分期和IBI是影响cHCC-CCA患者DFS和OS的独立因素(P<0.05)。结论IBI可做为评估cHCC-CCA患者预后的预测工具。

Objective To investigate the clinical significance of inflammatory burden index(IBI)in predicting prognosis of patients with combined hepatocellular carcinoma and intrahepatic cholangiocarcinoma(cHCC-CCA).Methods A retrospective data was conducted on a total of 106 patients diagnosed with cHCC-CCA after undergoing therapeutic liver resection in our hospital from January 2019 to February 2023.Based on the preoperative whole blood count,the systemic inflammatory index,including neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),monocyte to lymphocyte ratio(mlR),inflammatory burden index(IBI),and systemic immune inflammatory index(SII)were calculated.Overall survival(OS),and disease-free survival(DFS)was followed-up.Results Among the five inflammatory biomarker combination parameters,the C statistic of IBI in predicting the risk of death in cHCC-CCA patients was 0.822(95%CI:0.731-0.912),which was significantly higher than other indicators(P<0.05).All cHCC-CCA patients were divided into low IBI group(<101.03)and high IBI group(≥101.03)according to the IBI cutoff value.IBI values in cHCC-CCA patients were associated with higher T stage and AJCC stage and lower histological differentiation(P<0.05).The median DFS and OS of high IBI group was 16 months and 24 months,which was shorter than that of low IBI group(54 months and 40 months),and the differences were statistically significant(P<0.05).Univariate and multivariate Cox regression analysis showed that high IBI was one of the independent risk factors for postoperative death and recurrence of cHCC-CCA(P<0.05).Conclusion IBI could be a powerful prognostic factor for cHCC CCA and can serve as a useful tool in prognostic assessment.