术前中性粒细胞与淋巴细胞比值对肝癌肝移植术后肿瘤复发的影响  

Preoperative neutrophil-lymphocyte ratio as a prognostic predictor after liver transplantation for hepatoceHular carcinoma

作　　者：汪国营[1] 杨扬[1] 张琪[1] 李华[1] 陈冠中[1] 易述红[1] 许赤[1] 汪根树[1] 张剑[1] 易慧敏[1] 姜楠[1] 傅斌生[1] 赵辉[1] 李敏如[1] 陈颖华[1] 蔡常洁[1] 陆敏强[1] 陈规划[1] 

机构地区：[1]广东省器官移植研究中心中山大学器官移植研究所中山大学附属第三医院肝脏移植中心,广州510630

出　　处：《中华医学杂志》2011年第22期1519-1522,共4页National Medical Journal of China

基　　金：国家高技术研究“973”发展计划项目（2009CB522404）;国家自然科学基金（30972914;81000190）

摘　　要：目的评价肝癌肝移植患者术前外周血中性粒细胞／淋巴细胞比值（NLR）对术后肝癌复发的影响。方法回顾性分析中山大学第三附属医院76例乙型肝炎相关性肝细胞癌患者临床资料，单因素分析术前最大肿瘤直径、肿瘤数目、血管侵犯、甲胎蛋白（AFP）水平、中性粒细胞／淋巴细胞比值（NLR）、术后最大肿瘤直径、术后肿瘤数目和病理组织学分级等对术后无瘤生存率的影响，有统计学意义的术前单因素进入Cox回归模型多因素分析。结果1、3、5年的无瘤生存率分别为69．2％、52．7％和50．9％。NLR〈2．5和NLR≥2．5（37例）的患者1、3、5年的无瘤生存率分别为81．1％、66．9％、63．3％和56．3％、37．6％、37．6％（P=0．011）。单因素分析显示术前最大肿瘤直径〉5cm、肿瘤数目〉3、有大血管侵犯、AFP／〉400μg／L和NLRI〉2．5影响术后无瘤生存率。Cox回归分析显示肿瘤数目〉3、血管侵犯和NLR≥2．5为影响肝癌肝移植术后肿瘤复发的独立危险因素。结论术前高NLR的肝癌肝移植患者术后肿瘤复发的风险增加。Objective To analyze the negative impact of preoperative neutrophil-lymphocyte ratio （NLR） on the tumor recurrence of hepatocellular carcinoma （HCC） after orthotopic liver transplantation. Methods The clinical data of HBV （ hepatitis B virus） -associated HCC patients undergoing liver transplantation were retrospectively analyzed. Their clinical and pathological risk factors for tumor-free survival were evaluated by univariate analysis. The analysis of Cox multiple regression was performed to determine the parameters of predicting the HCC recurrence. NLR≥2. 5 was considered to be elevated. Results A total of 76 patients were identified. Among them, 37 had an elevated NLR. The 1, 3 and 5-year tumor-free survival rates were 69. 2%, 52. 7% and 50. 9% respectively. The disease-free survival for patients with high NLR was significantly worse than that for those with normal NLR （ 1, 3, and 5 year survivals at 56. 3%, 37. 6% and 37.6% vs 81.1% , 66. 9% and 63.3% respectively; P =0. 011 ）. Univariate analysis of factors revealed that tumor size 〉 5 cm, tumor number 〉 3, vascular invasion, serumctfetoprotein level I〉 400 μg/L and NLR≥2. 5 were preoperative predictors of disease-free survival. Cox regression analysis showed that the presence of vascular invasion, tumor number 〉 3 and NLR I〉 2. 5 were independent prognostic factors of worse disease-free survival. Conclusion An elevated NLR significantly increases the risk for tumor recurrence in HCC patients undergoing liver transplantation.

关 键 词：肝移植 肝细胞癌 预后 复发 无瘤生存率 

分 类 号：R735.7[医药卫生—肿瘤]