四种炎症标志物对HBV相关原发性肝癌术后预后的预测价值
Value of 4 inflammatory biomarkers in prognosis of patients with hepatitis B virus-related hepatocellular carcinoma after radical operation

目的:探讨术前外周血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)、预后营养指数(PNI)等炎症标志物与乙肝病毒(HBV)相关原发性肝癌患者根治性切除术后预后的关系。方法:回顾性分析接受根治性切除术的331例HBV相关原发性肝癌患者的临床及随访资料,计算NLR、PLR、MLR、PNI值。采用Kaplan-Meier法和Cox回归分析影响患者生存的因素。结果:NLR、PLR、MLR、PNI的界值分别为2.41、106.80、0.24、45。根据界值将患者分为高低两组。多因素分析显示,门静脉癌栓、术前AFP、AST、肝内播散及NLR是影响HBV相关原发性肝癌患者根治术后生存的独立危险因素,HR(95%CI)分别为2.652(1.863～3.776)、1.476(1.027～2.120)、1.437(1.047～1.972)、1.596(1.065～2.390)和1.563(1.077～2.268),PNI是此类患者术后生存的保护因素,HR(95%CI)为0.657(0.468～0.922)(P均<0.05)。结论:术前NLR及PNI与HBV相关原发性肝癌患者术后生存有关,低NLR及高PNI的患者预后较好。
Aim: To explore the prognostic value of pre-operative neutrophil to lymphocyte ratio(NLR), platelet to lymphocyte ratio(PLR), monocyte to lymphocyte ratio(MLR), prognostic nutritional index(PNI)in hepatitis B virus(HBV)-related hepatocellular carcinoma(HCC)after radical operation.Methods: A total of 331 HCC patients who had been undergone radical operation were followed up. The clinical and laboratory data of the patients were collected. The values of NLR,PLR,MLR, and PNI were calculated.Kaplan-Meier and Cox regression were used to analyze the risk factors.Results: The optimal cutoff levels of NLR, PLR, MLR and PNI were 2.41, 106.80, 0.24 and 45, respectively. The patients were allocated into two groups according to the cutoff levels. Multivariate analysis revealed that PVTT, pre-operative AFP,AST,intrahepatic metastasis, NLR and PNI were independent predictors of overall survival for HCC after hepatectomy, and HR(95%CI)were 2.652(1.863-3.776),1.476(1.027-2.120),1.437(1.047-1.972),1.596(1.065-2.390),1.563(1.077-2.268), and 0.657(0.468-0.922)(P<0.05).Conclusion: Pre-operative NLR and PNI were independent predictors of overall survival for HBV-related HCC after hepatectomy. The patients with low NLR and high PNI indicate better prognosis