术前外周血中性粒细胞与淋巴细胞比值评估肝细胞癌根治性切除术后预后的临床价值

目的 探讨肝细胞癌(HCC)患者术前外周血中性粒细胞与淋巴细胞的比值(NLR)对根治性切除术后预后评估的临床价值.方法 收集行HCC根治性切除术的161例HCC患者的临床资料,根据患者术前NLR值情况,将患者分为高NLR组(NLR≥2.60,n=52)及低NLR组(NLR﹤2.60,n=109).应用Kaplan-Meier方法分析患者的生存率,并采用Log-rank检验差异;采用Cox回归模型分析影响HCC患者总体生存率的预后因素.结果161例HCC患者的中位随访时间为29个月,高NLR组的1、3、5年总体生存率分别为79.6%、70.8%、41.1%,中位肿瘤复发时间14.9个月;低NLR组的1、3、5年总体生存率分别为90.4%、79.6%、48.7%,中位肿瘤复发时间为20.1个月,高NLR组的1、3、5年总体生存率均低于低NLR组(P﹤0.05),中位肿瘤复发时间短于低NLR组(P﹤0.05);单因素分析结果显示:肿瘤包膜、TNM分期、术前AFP、术前高NLR、淋巴结转移、肿瘤大小与HCC根治性切除术后预后生存时间有关,差异有统计学意义(P﹤0.05);Cox多因素分析结果显示:TNM分期为Ⅲ~Ⅳ期、术前AFP﹤400 ng/ml、术前NLR≥2.60、淋巴结转移、肿瘤大小≥10 mm为影响HCC患者根治性切除术后预后的独立危险因素(P﹤0.001).结论 术前NLR是影响HCC患者根治性切除术后预后的独立危险因素,可作为评估患者预后的指标,术前高NLR者其预后较差.

Clinical value of preoperative peripheral blood neutrophil-to-lymphocyte ratio in evaluating patient prognosis after radical resection of hepatocellular carcinoma

Objective To evaluate the clinical value of preoperative peripheral blood neutrophil-to-lymphocyte ratio (NLR) in evaluating patient prognosis after radical resection of hepatocellular carcinoma (HCC). Method The clinical data of 161 patients with HCC who had undergone radical resection of HCC were collected, and the patients were divided into high NLR group (NLR≥2.60,n=52) and low NLR group (NLR<2.60,n=109) according to the preoperative NLR val-ue. The survival rate was analyzed using Kaplan-Meier method, and the difference was checked by Log-rank test. The Cox regression model was used to analyze the prognostic factors for overall survival rate in patients with HCC. Result The median follow-up time of the 161 HCC patients was 29 months. The overall 1-, 3-, and 5-year survival rates of the high NLR group were 79.6%, 70.8%and 41.1%, respectively, and the median time to tumor recurrence was 14.9 months. The overall 1-, 3-, and 5-year survival rates of low NLR group were 90.4%, 79.6%, 48.7%, and the median time to tumor recurrence time was 20.1 months. The overall 1-, 3-, and 5-year survival rates of the high NLR group were all lower than those of the low NLR group (P<0.05), and the median time to tumor recurrence was shorter than that of low NLR group (P<0.05). The results of univariate analysis showed that tumor envelope, TNM staging, preoperative AFP, preoperative high NLR, lymph node metastasis, and tumor size were related to the prognosis and survival time after radical resection of HCC, and the differences were statistically significant (P<0.05). The results of Cox multivariate analysis showed that stageⅢ-Ⅳin TNM staging system, preoperative AFP<400 ng/ml, preoperative NLR≥2.60, lymph node metastasis, tu-mor size≥10 mm were the independent prognostic factors for patients after radical resection of HCC (P<0.001). Conclu-sion Preoperative NLR is an independent risk factor for the prognosis of patients after radical resection of HCC. It can be used as an indicator to evaluate the prognosis of patients, and the prognosis of patients with high preoperative NLR is poor.