术前炎症指标对肝细胞癌肝切除术患者的预后预测价值

目的  探讨术前炎症指标中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）和预后营养指数（PNI）在肝细胞癌（HCC）肝切除术后患者预后中的预测价值。方法 本研究为回顾性队列研究。选择2015年6月—2018年3月于本院行肝切除术的HCC患者为研究对象，随访截至2021年1月。主要研究指标为总生存期（OS）。采用限制性立方样条、Cox比例风险回归模型、时间依赖的受试者工作特征（ROC）曲线以及列线图评估术前NLR、PLR及PNI的预后预测价值。结果 共77例患者符合标准纳入分析，其中男性59例；中位年龄51岁。限制性立方样条分析结果显示，NLR、PLR、PNI与HCC患者的死亡风险均呈线性关系（非线性P>0.05），Cox比例风险回归模型结果显示，NLR、PLR、PNI、肿瘤分化程度及肿瘤包膜是否完整是影响HCC患者OS的因素。NLR、PLR、PNI等炎症指标构建的列线图模型预测1年、3年总生存率的AUC均大于NLR、PLR、PNI（均P<0.05），且联合预后影响因素肿瘤分化程度和肿瘤包膜是否完整后AUC进一步提高（均P<0.05）。结论 术前炎症指标NLR、PLR、PNI在预测肝细胞癌肝切除术患者预后中具有良好效能，联合临床因素可进一步提高预测效能。

Predictive value of preoperative inflammation indexes for the prognostis of hepatocellular carcinoma patients after hepatectomy

Objective To investigate the value of preoperative inflammatory indexes, including neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and prognostic nutritional index (PNI), in predicting the prognosis of hepatocellular carcinoma (HCC) after hepatectomy. Methods This retrospective cohort study selected patients who underwent hepatectomy in the Third People's Hospital of Sichuan from June 2015 to March 2018 as the research subjects, and the follow-up was as of January 2021. The main outcome was overall survival (OS). The prognostic values of preoperative NLR, PLR and PNI were evaluated by restricted cubic spline, Cox proportional hazard regression model, time-dependent receiver operating characteristic (ROC) curve and nomogram. Results A total of 77 patients reached the standard analysis, including 59 males, with a median age of 51 years. The results of restricted cubic spline analysis showed that the death risk of HCC patients was linearly related to NLR, PLR, and PNI (non-linear P>0.05), and the Cox proportional hazard regression model showed that NLR, PLR, PNI, tumor differentiation degree and tumor envelope integrity were factors affecting OS. The AUC of 1-year and 3-year OS rates predicted by nomogram model constructed by NLR, PLR, PNI were greater than that of NLR, PLR, and PNI (all P<0.05). The AUC would be further improved after the combination of the degree of tumor differentiation and tumor envelope integrity (all P<0.05). Conclusions Preoperative inflammatory indexes NLR, PLR and PNI have good efficacy in predicting the prognosis of patients undergoing hepatectomy, and the combination of clinical factors can further improve the predictive performance.