外周血免疫炎症细胞与肝细胞癌预后的关系

The association of pre-operative peripheral blood-drive inflammatory immune cell and prognosis of patients with hepatocellular carcinoma

目的探讨肝细胞癌患者术前外周血免疫炎症细胞和临床病理特征及预后的关系。方法回顾性分析2010年1月~2013年12月在安徽医科大学第一附属医院普外科接受根治性切除手术的113例患者的临床病理资料,根据患者术前外周血中性粒细胞、淋巴细胞及血小板,计算中性粒细胞与淋巴细胞比值(Neutrophil-to-lymphocyte ratio, NLR)、血小板与淋巴细胞比值(platelet-to-lymphocyte ratio, PLR),采用Kaplan-Meier生存曲线和Cox比例风险模型探索术前外周血炎症免疫细胞对肝细胞癌患者预后的影响。结果外周血淋巴细胞数与患者AFP相关(P=0.022),与余临床病理因素之间差异均无统计学意义(P>0.05)。血中性粒细胞、血小板、NLR及PLR亦与各个临床病理因素之间均无明显相关(P>0.05)。生存分析发现,淋巴细胞高值组和低值组之间总体生存期差异有统计学意义(P=0.005)。其中单因素生存分析显示:患者AFP值、血管侵犯、肿瘤最大直径、肿瘤数目及巴塞罗那分期是影响患者预后的危险因素。将各临床病理因素纳入多因素COX风险比例函数模型分析,结果显示:淋巴细胞(HR=0.576, 95%CI:0.343~0.967)是肝细胞癌患者预后的独立危险因素(P=0.037)。结论术前外周血淋巴细胞数值高值组肝细胞癌患者术后总体生存率较低值组高,预后较好。

Objective To investigate the relationship of pre-operative peripheral blood-drive inflammatory immune cells and clinicopathological features,and prognoses of patients of hepatocellular carcinoma.Methods This a retrospective study of 113 consecutive patients with hepatocellular carcinoma who under radical resection in the first affiliated hospital of Anhui medical university between January 2010 to December 2013.The pre-operative peripheral blood was collected for cell blood count.Neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)were calculated.Survival cure was analyses by Kaplan-Meier method and the association of prognosis and inflammatory immune cell were analyses by Cox proportional hazard model.Results The expression of the peripheral blood lymphocytes was significantly associated with preoperative AFP(P=0.022),and there is no significant relation between clinicopathological characteristics to other peripheral blood-drive inflammatory immune cells counts(P>0.05).Kaplan-Meier analysis showed that compare to low-group peripheral blood lymphocytes,high-group of peripheral blood lymphocytes is associated with better overall survival(OS,P=0.005).In univariate analysis,increased AFP,vascular invasion,tumor size,multiple tumors and Barcelona stages are significantly associated with poor OS(P<0.05).Lymphocytes(HR=0.576,95%CI:0.343~0.967)is an independent risk factor of prognosis of patients with hepatocellular carcinoma in multivariate analysis(P=0.037).Conclusion Patients with higher levels of preoperative peripheral blood-drive lymphocytes have longer OS and is an independent risk factor of prognosis of patients with hepatocellular carcinoma.