炎症预后指数对经导管肝动脉化疗栓塞术治疗肝癌疗效的评估价值

目的:探讨以血清中白蛋白(ALB)、淋巴细胞计数、C反应蛋白(CRP)、中性粒细胞与淋巴细胞比率(NLR)为基础的炎症预后指数(IPI)在经导管肝动脉化疗栓塞术（TACE）治疗肝癌中的疗效以及预后评估价值。方法:回顾分析2014年01月至2016年12月在我院接受肝动脉化疗栓塞术治疗的286例肝癌患者的临床资料，计算患者IPI。采用受试者工作特征（ROC）曲线计算IPI截断值，并采用单因素和多因素COX回归分析探讨影响患者术后生存情况的独立影响因素。结果:随访期间24例患者失访，以IPI=14.56为临界值，将随访有效的262例肝癌患者分为高IPI组（n=154）和低IPI组(n=108)；临床病理资料分析结果显示，病灶数量、肿瘤最大径、是否存在门脉癌栓、AFP水平、TNM分级对肝癌患者的IPI表达水平具有显著影响（P＜0.05）；随访期间共死亡68例，中位生存时间为9个月；其中高IPI组死亡53例，中位生存时间为6（1~28）个月；低IPI组死亡15例，中位生存时间为13（4~36）个月，两组患者中位生存时间差异具有统计学意义（P=0.015)；多因素COX回归分析结果显示肿瘤IPI>14.56（OR=5.689，95%CI 1.589~13.254）是影响肝癌患者预后的独立危险因素。结论:NLR、CRP、ALB、IPI均是影响肝癌患者TACE术后预后的独立危险因素，以NLR、CRP、ALB为基础的IPI对于预测肝癌患者手术疗效和预后生存情况具有重要价值。

Evaluation value of inflammation prognosis index in transcatheter hepatic artery chemoembolization for liver cancer

Objective:To investigate the inflammation prognosis index (IPI) based on serum albumin (ALB),lymphocyte count,C reaction protein (CRP),and neutrophil/lymphocyteratio (NLR) in transcatheter hepatic artery chemoembolization (TACE) treatment of liver cancer and its prognostic value.Methods:The clinical data of 286 patients with liver cancer who underwent hepatic artery chemoembolization in our hospital from January 2014 to December 2016 were retrospectively analyzed.Receiver operating characteristic curve (ROC) was used to calculate the IPI cutoff value.The univariate and multivariate COX regression analysis was used to explore the independent influencing factors that affected patients' postoperative survival.Results:During the follow-up,24 patients were lost to follow-up.IPI=14.56 was used as the cutoff value.The 262 patients with liver cancer who were followed effectively were divided into high IPI group (n=154) and low IPI group (n=108).The analysis of clinicopathological data showed that the number of lesions,the largest tumor diameter,the presence of portal tumor thrombus,AFP level,and TNM classification had significant effects on the expression of IPI in patients with liver cancer (P＜0.05).A total of 68 patients died during the follow-up period,with a median survival time of 9 months.Among them,53 patients died in the high IPI group,with a median survival time of 6 (1~28) months.15 patients died in the low IPI group,with a median survival time of at 13 (4~36) months,the difference in median survival time between the two groups of patients was statistically significant (P= 0.015).Multivariate COX regression analysis showed that tumor IPI>14.56 (OR=5.689,95%CI 1.589~13.254) was an independent risk factor affecting the prognosis of patients with liver cancer.Conclusion:NLR,CRP,ALB,and IPI are all independent risk factors that affect the prognosis of patients with liver cancer after TACE.IPI based on NLR,CRP,and ALB is of great value in predicting the curative effect and survival of patients with liver cancer.