微创治疗前NLR对青年肝癌疗效的影响
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摘要
目的探讨射频消融(RFA)术前和经导管动脉化疗栓塞(TACE)术前中性粒细胞/淋巴细胞比值(NLR)对青年肝癌患者疗效的影响。方法回顾性分析47例青年肝癌患者的临床资料并随访,以NLR=3.09作为临界值将患者分为NLR≥3.09组(21例)和NLR<3.09组(26例)。采用Log-rank单因素分析临床病理因素对无进展生存时间(PFS)的影响,采用Cox回归模型进行多因素风险分析。结果 47例患者中位PFS时间为3.0个月(1.0～66.0个月);其中NLR<3.09组中位PFS时间为5.0个月(1.0～66.0个月),长于NLR≥3.09组的3.0个月(1.0～13.0个月),差异具有统计学意义(P<0.05)。单因素分析结果显示:巴塞罗那(BCLC)分期、谷草转氨酶(AST)、血管侵犯、肿瘤最大径、NLR与PFS有关(P<0.05)。根据单因素分析结果 ,进一步用Cox回归模型进行多因素分析,发现NLR、AST、血管侵犯、BCLC分期对PFS无明显影响(P>0.05),肿瘤最大径≥5 cm是青年肝癌患者微创治疗疗效不佳的独立预测因素(P<0.05)。结论微创治疗前NLR≥3.09是青年肝癌患者微创治疗疗效不佳的危险因素,肿瘤最大径≥5 cm是青年肝癌患者微创治疗疗效不佳的独立预测因素。
Objective To discuss the influence of neutrophil/lymphocyte ratio(NLR) on efficacy of young patients with liver cancer before radiofrequency ablation(RFA) and transcatheter arterial chemoembolization(TACE) preoperative. Methods The clinical data of 47 patients with hepatocellular carcinoma were retrospectively analyzed and followed up. NLR=3.09 was taken as the cut-off value to divide patients into NLR≥3.09 group(21 cases) and NLR<3.09 group(26 cases). Log-rank single factor analysis was used to analyze the effect of clinicopathological factors on progression-free survival(PFS), and Cox regression model was used to analyze the risk of multiple factors. Results The median PFS time of 47 patients was 3.0 months(1.0～66.0 months). The median PFS time in the NLR<3.09 group was 5.0 months(1.0～66.0 months), which was longer than 3.0 months(1.0～13.0 months) in the NLR≥3.09 group, and the difference was statistically significant(P<0.05). Univariate analysis showed that the stages of Barcelona(BCLC), aspartate aminotransferase(AST), vascular invasion, maximum diameter of tumors and NLR were associated with PFS(P<0.05). According to the results of single factor analysis, the multivariate analysis was further performed by Cox regression model. It was found that NLR, AST, vascular invasion and BCLC staging had no significant effect on PFS(P>0.05). The maximum diameter of tumors ≥5 cm was an independent predictor of the poor efficacy of minimally invasive treatment in young patients with hepatocellular carcinoma(P<0.05). Conclusion NLR ≥3.09 before minimally invasive treatment is a risk factor for poor efficacy of minimally invasive treatment in young patients with hepatocellular carcinoma. The maximum diameter of tumor ≥5 cm is an independent predictor of poor efficacy of minimally invasive treatment in young patients with hepatocellular carcinoma.
Objective To discuss the influence of neutrophil/lymphocyte ratio(NLR) on efficacy of young patients with liver cancer before radiofrequency ablation(RFA) and transcatheter arterial chemoembolization(TACE) preoperative. Methods The clinical data of 47 patients with hepatocellular carcinoma were retrospectively analyzed and followed up. NLR=3.09 was taken as the cut-off value to divide patients into NLR≥3.09 group(21 cases) and NLR<3.09 group(26 cases). Log-rank single factor analysis was used to analyze the effect of clinicopathological factors on progression-free survival(PFS), and Cox regression model was used to analyze the risk of multiple factors. Results The median PFS time of 47 patients was 3.0 months(1.0～66.0 months). The median PFS time in the NLR<3.09 group was 5.0 months(1.0～66.0 months), which was longer than 3.0 months(1.0～13.0 months) in the NLR≥3.09 group, and the difference was statistically significant(P<0.05). Univariate analysis showed that the stages of Barcelona(BCLC), aspartate aminotransferase(AST), vascular invasion, maximum diameter of tumors and NLR were associated with PFS(P<0.05). According to the results of single factor analysis, the multivariate analysis was further performed by Cox regression model. It was found that NLR, AST, vascular invasion and BCLC staging had no significant effect on PFS(P>0.05). The maximum diameter of tumors ≥5 cm was an independent predictor of the poor efficacy of minimally invasive treatment in young patients with hepatocellular carcinoma(P<0.05). Conclusion NLR ≥3.09 before minimally invasive treatment is a risk factor for poor efficacy of minimally invasive treatment in young patients with hepatocellular carcinoma. The maximum diameter of tumor ≥5 cm is an independent predictor of poor efficacy of minimally invasive treatment in young patients with hepatocellular carcinoma.
引文
[1]Ji F, Fu SJ, Shen SL, et al. The prognostic value of combined TGF-β1 and ELF in hepatocellular carcinoma. BMC Cancer, 2015,15(1):116.
[2]杨学刚,许国辉,吴戈.青年肝癌介入治疗研究进展.肿瘤预防和治疗, 2012, 25(4):263-266.
[3]Ferrucci PF, Gandini S, Battaglia A, et al. Baseline neutrophil-tolymphocyte ratio is associated with outcome of ipilimumab-treated metastatic melanoma patients. Br J Cancer, 2015, 112(12):1904-1910.
[4]LuéA, Serrano MT,Bustamante FJ, et al. Neutrophil-to-lymphocyte ratio predicts survival in European patients with hepatocellular carcinoma administered sorafenib. Oncotarget, 2017, 61(8):103077-103086.
[5]Mc Nally ME, Martinez A,Khabiri H, et al. Inflammatory markers are associated with outcome in patients with unresectable hepatocellular carcinoma undergoing transarterial chemoembolization. Ann Surg Oncol, 2013, 20(3):923-928.
[6]Sullivan KM,Groeschl RT, Turaga KK, et al. Neutrophil-tolymphocyte ratio as a predictor of outcomes for patients with hepatocellularcarcinoma:a Western perspective. J Surg Oncol, 2014,109(2):95-97.
[7]Casadei Gardini A, Scarpi E, Faloppi L, et al. Immune inflammation indicators and implication for immune modulation strategies in advanced hepatocellular carcinoma patients receiving sorafenib.Oncotarget, 2016, 7(41):67142-67149.
[8]Terashima T, Yamashita T, Iida N, et al. Blood neutrophil to lymphocyte ratio as a predictor in patIents with advanced hepatocellular carcinoma treated with hepatic arterial infusion chemotherapy. Hepatol Res, 2015,45(9):949-959.
[9]袁琳,万磊,陈佳佳,等.术前TTV、NLR及HBV-DNA定量对预测肝癌术后复发的价值.现代消化及介入诊疗, 2015(2):99-102.
[10]汪国营,杨扬,张琪,等.肝移植术后肿瘤复发的影响.中华医学杂志, 2011, 91(22):1519-1522.
[11]李金鹏,胡善亮,陈华,等. NLR对肝癌TACE患者预后影响的分析.中华肿瘤防治杂志, 2013, 20(7):522-525.
[12]马晓路,吴炯,周琰,等.术前中性粒细胞/淋巴细胞比值对肝细胞肝癌根治性切除术后肿瘤早期复发的影响.检验医学,2016, 31(10):863-868.
[13]张远标,卢毅,吴伟顶,等.术前中性粒细胞/淋巴细胞比值在甲胎蛋白阴性肝细胞肝癌术后复发中的预测价值.中华普通外科杂志, 2016, 31(5):387-390.
[14]汪国营,李华,张琪,等.一种预测肝癌肝移植术后肿瘤复发的术前评分模型.中华肝胆外科杂志, 2012, 18(5):325-329.
[15]王卫.肝癌肝移植受者术前粒淋比对受者预后影响的研究.浙江大学, 2014.
[16]左宏平,周瑜,卢震辉.外周血相关参数对肝癌预后评估价值的研究进展.中国卫生标准管理, 2017, 8(19):78-80.
[17]Taussig MD, Irene Koran ME, Mouli SK, et al. Neutrophil to Lymphocyte Ratio Predicts Disease Progression Following IntraArterial Therapy of Hepatocellular Carcinoma. HPB(Oxford), 2017,19(5):458-464.
[18]Li X, Han Z, Cheng Z, et al. Preoperative Neutrophil-to-Lymphocyte Ratio Is a Predictor of Recurrence following Thermal Ablation for Recurrent Hepatocellular Carcinoma:A Retrospective Analysis. PLOS ONE, 2014, 9(10):e110546.
[2]杨学刚,许国辉,吴戈.青年肝癌介入治疗研究进展.肿瘤预防和治疗, 2012, 25(4):263-266.
[3]Ferrucci PF, Gandini S, Battaglia A, et al. Baseline neutrophil-tolymphocyte ratio is associated with outcome of ipilimumab-treated metastatic melanoma patients. Br J Cancer, 2015, 112(12):1904-1910.
[4]LuéA, Serrano MT,Bustamante FJ, et al. Neutrophil-to-lymphocyte ratio predicts survival in European patients with hepatocellular carcinoma administered sorafenib. Oncotarget, 2017, 61(8):103077-103086.
[5]Mc Nally ME, Martinez A,Khabiri H, et al. Inflammatory markers are associated with outcome in patients with unresectable hepatocellular carcinoma undergoing transarterial chemoembolization. Ann Surg Oncol, 2013, 20(3):923-928.
[6]Sullivan KM,Groeschl RT, Turaga KK, et al. Neutrophil-tolymphocyte ratio as a predictor of outcomes for patients with hepatocellularcarcinoma:a Western perspective. J Surg Oncol, 2014,109(2):95-97.
[7]Casadei Gardini A, Scarpi E, Faloppi L, et al. Immune inflammation indicators and implication for immune modulation strategies in advanced hepatocellular carcinoma patients receiving sorafenib.Oncotarget, 2016, 7(41):67142-67149.
[8]Terashima T, Yamashita T, Iida N, et al. Blood neutrophil to lymphocyte ratio as a predictor in patIents with advanced hepatocellular carcinoma treated with hepatic arterial infusion chemotherapy. Hepatol Res, 2015,45(9):949-959.
[9]袁琳,万磊,陈佳佳,等.术前TTV、NLR及HBV-DNA定量对预测肝癌术后复发的价值.现代消化及介入诊疗, 2015(2):99-102.
[10]汪国营,杨扬,张琪,等.肝移植术后肿瘤复发的影响.中华医学杂志, 2011, 91(22):1519-1522.
[11]李金鹏,胡善亮,陈华,等. NLR对肝癌TACE患者预后影响的分析.中华肿瘤防治杂志, 2013, 20(7):522-525.
[12]马晓路,吴炯,周琰,等.术前中性粒细胞/淋巴细胞比值对肝细胞肝癌根治性切除术后肿瘤早期复发的影响.检验医学,2016, 31(10):863-868.
[13]张远标,卢毅,吴伟顶,等.术前中性粒细胞/淋巴细胞比值在甲胎蛋白阴性肝细胞肝癌术后复发中的预测价值.中华普通外科杂志, 2016, 31(5):387-390.
[14]汪国营,李华,张琪,等.一种预测肝癌肝移植术后肿瘤复发的术前评分模型.中华肝胆外科杂志, 2012, 18(5):325-329.
[15]王卫.肝癌肝移植受者术前粒淋比对受者预后影响的研究.浙江大学, 2014.
[16]左宏平,周瑜,卢震辉.外周血相关参数对肝癌预后评估价值的研究进展.中国卫生标准管理, 2017, 8(19):78-80.
[17]Taussig MD, Irene Koran ME, Mouli SK, et al. Neutrophil to Lymphocyte Ratio Predicts Disease Progression Following IntraArterial Therapy of Hepatocellular Carcinoma. HPB(Oxford), 2017,19(5):458-464.
[18]Li X, Han Z, Cheng Z, et al. Preoperative Neutrophil-to-Lymphocyte Ratio Is a Predictor of Recurrence following Thermal Ablation for Recurrent Hepatocellular Carcinoma:A Retrospective Analysis. PLOS ONE, 2014, 9(10):e110546.