肝细胞肝癌患者术前NLR、APRI与临床病理特征及预后的关系
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摘要
目的探讨患者术前中性淋巴细胞比率(NLR)、门冬氨酸氨基转移酶血小板比率(APRI)与临床病理特征及预后的关系。方法回顾性分析行肝细胞肝癌切除术的263例患者的临床资料,应用X-Tile软件确定NLR、APRI的最佳截断值,分析NLR、APRI与患者临床病理特征及预后的关系。结果 NLR、APRI的最佳截断值分别为2.4、0.3。术前NLR≥2.4患者与NLR<2.4患者相比,肝脏破裂出血风险较大、肿瘤较大、肿瘤数量较多(均P<0.05),术前APRI<0.3患者与APRI≥0.3患者相比,血管侵犯与肝硬化发生率、AFP水平较高(均P<0.05)。NLR<2.4且APRI≥0.3患者1、3、5年无瘤生存率与总生存率>NLR≥2.4且APRI≥0.3或NLR<2.4且APRI<0.3患者>NLR≥2.4且APRI<0.3患者(均P<0.05)。结论术前高NLR、低APRI肝细胞肝癌患者术后生存时间较短,预后较差。
Objective To investigate the correlation of preoperative neutrophil-to-lymphocyte ratio(NLR) and aspartate aminotransferase/platelet count ratio index( APRI) with clinicopathological characteristics and prognosis of patients with hepatocellular carcinoma(HCC). Methods Clinical Data of 263 patients with HCC who underwent curative resection were retrospectively analyzed. The optimal cut-off points of preoperative NLR and APRI to predict the postoperative survival of patients were determined by X-TILE software. The correlation of preoperative NLR, APRI with clinicopathological characteristics and prognosis of patients was analyzed. Results The optimal cut-off points of preoperative NLR, APRI to predict the postoperative survival of HCC patients were 2.4 and 0.3, respectively. Patients with preoperative NLR ≥2.4 had a higher risk of liver rupture and hemorrhage, a larger tumor and more malignant lesions than patients with NLR <2.4(all P <0.05). Patients with preoperative APRI <0.3 had a higher incidence of vascular invasion and cirrhosis and a higher AFP level than patients with APRI ≥0.3(all P<0.05). The 1-year, 3-year and 5-year disease-free survival rates and the overall survival rates were the highest in HCC patients with preoperative NLR≥2.4 and APRI<0.3/NLR<2.4 and APRI<0.3,while those in patients with NLR≥2.4 and APRI<0.3 were lowest. Conclusion Higher levels of preoperative NLR or lower levels of preoperative APRI predict shorter survival time and poorer outcomes in HCC patients.
Objective To investigate the correlation of preoperative neutrophil-to-lymphocyte ratio(NLR) and aspartate aminotransferase/platelet count ratio index( APRI) with clinicopathological characteristics and prognosis of patients with hepatocellular carcinoma(HCC). Methods Clinical Data of 263 patients with HCC who underwent curative resection were retrospectively analyzed. The optimal cut-off points of preoperative NLR and APRI to predict the postoperative survival of patients were determined by X-TILE software. The correlation of preoperative NLR, APRI with clinicopathological characteristics and prognosis of patients was analyzed. Results The optimal cut-off points of preoperative NLR, APRI to predict the postoperative survival of HCC patients were 2.4 and 0.3, respectively. Patients with preoperative NLR ≥2.4 had a higher risk of liver rupture and hemorrhage, a larger tumor and more malignant lesions than patients with NLR <2.4(all P <0.05). Patients with preoperative APRI <0.3 had a higher incidence of vascular invasion and cirrhosis and a higher AFP level than patients with APRI ≥0.3(all P<0.05). The 1-year, 3-year and 5-year disease-free survival rates and the overall survival rates were the highest in HCC patients with preoperative NLR≥2.4 and APRI<0.3/NLR<2.4 and APRI<0.3,while those in patients with NLR≥2.4 and APRI<0.3 were lowest. Conclusion Higher levels of preoperative NLR or lower levels of preoperative APRI predict shorter survival time and poorer outcomes in HCC patients.
引文
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[27] Gao J, Zhang HY, Xia YF, et al. Increased platelet count is an indicator of metastasis in patients with nasopharyngeal carcinoma[J]. Tumour Biol, 2013, 34:39-45.
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[2] Roxburgh CS, Mc Millan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer[J]. Future Oncol, 2010, 6(1):149-163.
[3] Coussens LM, Werb Z. Inflammation and cancer[J]. Nature, 2002,19-26(6917):860-867.
[4] Balkwill F, Mantovani A. Inflammation and cancer:back to Virchow?[J].Lancet, 2001, 357(9255):539-545.
[5] Jaiswal M, La Russo NF, Burgart LJ, et al. Inflammatory cytokines induce DNA damage and inhibit DNA repair in cholangiocarcinoma cells by a nitricoxide-dependent mechanism[J]. Cancer Res,2000, 60(1):184-190.
[6] Motomura T, Shirabe K, Mano Y, et al. Neutrophil-lymphocyte ratio reflects hepatocellular carcinoma recurrence after liver transplantation via inflammatory microenvironment[J]. J Hepatol,2013,58(1):58-64.
[7] Gao F, Li X, Geng M, et al. Pretreatment neutrophil-lymphocyte ratio:an independent predictor of survival in patients with hepatocellular carcinoma[J]. Medicine, 2015, 94(11):e639.
[8] Kinoshita A, Onoda H, Imai N, et al. The glasgow prognostic score,an inflammation based prognostic score, predicts survival in patients with hepatocellular carcinoma[J]. BMC Cancer, 2013, 13(1):52.
[9] Chan AW, Chan SL, Wong GL, et al. Prognostic Nutritional Index(PNI)predicts tumor recurrence of very early/early stage hepatocellular carcinoma after surgical resection[J]. Ann Surg Oncol,2015, 22(13):4138-4148.
[10] Li X,Chen ZH,Xing YF,et al. Platelet-to-lymphocyte ratio acts as a prognostic factor for patients with advanced hepatocellular carcinoma[J].Tumor Biol,2015,36(4):2263-2269.
[11] Gassmann P, Spieker T, Haier J, et al. Prognostic impact of underlying liver fibrosis and cirrhosis after curative resection of hepatocellular carcinoma[J]. World J Surg, 2010, 34(10):2442-2451.
[12] Kaibori M, Kubo S, Nagano H, et al. Clinicopathological features of recurence in patients after 10-year disease-free survival following curative hepatic resection of hepatocellular carcinoma[J].World J Surg,2013,37(4):820-828.
[13] Shen SL, Fu SJ, Chen B, et al. Preoperative aspartate aminotransferase to platelet ratio is an independent prognostic factor for hepatitis B-induced hepatocellular carcinoma after hepatic resection[J]. Ann Surg Oncol,2014, 21(12):3802-3809.
[14] Toyoda H, Kumada T, Tada T, et al. A laboratory marker, FIB-4 index,as a predictor for longterm outcomes of hepatocellular carcinoma patients after curative hepatic resection[J]. Surgery,2015,157(4):699-707.
[15] Heikkila K, Ebrahim S, Lawlor DA. A systematic review of the association between circulating concentrations of C reactive protein and cancer[J]. J Epidemiol Community Health, 2007, 61(9):824-833.
[16] Mantovani A, Allavena P, Sica A, et al. Cancer-related inflammation[J].Nature, 2008, 24:454(7203):436-444.
[17] Elinav E, Nowarski R, Thaiss CA, et al. Inflammation induced cancer:crosstalk between tumours,immune cells and microorganisms[J]. Nat Rev Cancer, 2013,13(11):759-771.
[18]李红钢,陈福春,喻伦银,等.炎症诱导酶在大鼠肺鳞癌发生发展中的表达[J].中华肿瘤杂志,2002,24(4):316-319.
[19]叶劲松,向邦德,陈能志,等.中性粒细胞与淋巴细胞比值预测肝细胞癌患者预后的价值[J].中华肝胆外科杂志,2017,3(23):158-161.
[20] Motomura T, Shirabe K, Mano Y, et al. Neutrophil-lymphocyte ratio reflects hepatocellular carcinoma recurrence after liver transplantation via inflammatory microenvironment[J]. Journal of Hepatology,2013,58(1):58-64.
[21] Xue P, Kanai M, Mori Y, et al. Neutrophil-to-lymphocyte ratio for predicting palliative chemotherapy outcomes in advanced pancreatic cancer patients[J]. Cancer Med, 2014, 3(2):406-415.
[22] Toh E, Wilson J, Sebag-Montefiore D, et al. Neutrophil/lymphocyte ratio as a simple and novel biomarker for prediction of locoregional recurrence after chemoradiotherapy for squamous cell carcinoma of the anus[J].Colorectal Dis,2014,16(3):90-97.
[23] Kosumi K, Baba Y, Ishimoto T, et al. Neutrophil/lymphocyte ratio predicts the prognosis in esophageal squamous cell carcinoma patients[J].Surg Today,2016,46(4):405-413.
[24] Hung HH, Su CW, Lai CR, et al. Fibrosis and AST to platelet ratio index predict postoperative prognosis for solitary small hepatitis B-related hepatocellular carcinoma[J]. Hepatol Int, 2010, 24(4):691-699.
[25] Ma J, Jiang Y, Gong G, et al. Evaluation of seven noninvasive models in staging liver fibrosis in patients with chronic hepatitis B virus infection[J]. Eur J Gastroenterol Hepatol, 2013, 25(4):428-434.
[26] Boursier J, Brochard C, Bertrais S, et al. Combination of blood tests for significant fibrosis and cirrhosis improves the assessment of liver prognosis in chronic hepatitis C[J]. Aliment Pharmacol Ther,2014,40(2):178-188.
[27] Gao J, Zhang HY, Xia YF, et al. Increased platelet count is an indicator of metastasis in patients with nasopharyngeal carcinoma[J]. Tumour Biol, 2013, 34:39-45.
[28] Lin MS, Huang JX, Zhu J, et al. Elevation of platelet count in patients with colorectal cancer predicts tendency to metastases and poor prognosis[J]. Hepatogastroenterology, 2012, 59(118):1687-1690.
[29] Amano H, Tashiro H, Oshita A, et al. Significance of platelet count in the outcomes of hepatectomized patients with hepatocellular carcinoma exceeding the Milan criteria[J]. J Gastrointest Surg,2011,15(7):1173-1181.