术前外周血NLR、d-NLR和LMR对肝细胞癌根治性切除术后肿瘤早期复发的预测价值及危险因素分析  

The predictive value and risk factors of preoperative peripheral blood NLR,d-NLR and LMR on early tumor recurrence after radical resection of hepatocellular carcinoma

作　　者：陈攀[1] 冯留顺[1] 潘洁[1] 张蒙蒙 Chen Pan;Feng Liushun;Pan Jie;Zhang Mengmeng(The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院,河南郑州450000

出　　处：《河南医学研究》2018年第4期608-611,共4页Henan Medical Research

摘　　要：目的评价术前中性粒细胞/与淋巴细胞(NLR)、派生中性粒细胞/淋巴细胞(d-NLR)和淋巴细胞/单核细胞(LMR)对肝细胞癌根治性切除术后肿瘤早期复发的预测价值,并探讨肝细胞癌根治术后早期复发的危险因素。方法回顾性分析2015年5月至2016年5月郑州大学第一附属医院156例行肝细胞癌根治术患者1 a内的随访资料。根据患者术前最近一次血常规结果计算NLR、d-NLR、LMR值,绘制ROC曲线并确定最佳临界值,采用Kaplan-Meier法计算无瘤生存率,Log-rank法比较组间差异。COX单因素回归模型分析各临床参数对肝细胞癌根治术后患者早期复发的影响,有统计学意义的纳入多因素COX回归模型,确定肝细胞癌根治术后患者早期复发的独立危险因素。结果至1 a随访期结束,156例患者有58例复发,98例未复发,复发率为37.2%,中位随访时间为162 d。ROC曲线显示NLR、d-NLR曲线下面积分别为0.726和0.712,最佳临界点为1.58和1.34。LMR曲线下面积小于0.5,不能作为肝细胞癌根治术后患者早期复发的预测指标。Log-rank法分析显示不同NLR、d-NLR对肝细胞癌根治术后患者无瘤生存率的影响有统计学意义(P<0.05)。COX单因素回归模型分析显示高NLR、高d-NLR、肿瘤直径、血管侵犯和术前高AFP是肝细胞癌根治术后患者早期复发的危险因素。COX多因素回归模型分析示高NLR、肿瘤直径是影响术后肿瘤早期复发的独立危险因素。结论 NLR是一个简便、低成本的检验指标,对肝细胞癌根治术后早期复发具有预测价值,dNLR、LMR不能作为肝细胞癌根治术后肿瘤早期复发的预测指标。NLR>1.58和肿瘤最大径>5 cm是肝细胞癌根治术后早期复发的独立危险因素。Objective To evaluate the predictive value of neutrophil-to-lymphocyte ratio,derived neutrophil-to-lymphocyte ratio and lymphocyte-to-monocyte ratio on early tumor recurrence after radical resection of hepatocellular carcinoma,and to discuss the independent risk factors for early recurrence of hepatocellular carcinoma.Methods Retrospective analysis within 1 year was performed on 156 patients with radical resection of hepatocellular carcinoma in the First Affiliated Hospital of Zhengzhou University from May 2015 to May 2016.According to the recent blood routine results of the patients,NLR,d-NLR and LMR values were calculated.The ROC curve was drawn and the optimal threshold was determined.Kaplan-meier method was used to calculate the survival rate of the non-tumor,and the log-rank method was used to compare the differences between groups.The single factor COX regression model was used to analysis the clinical parameters of early recurrence of radical resection of hepatocellular carcinoma,and the multiple factors COX regression model was used in statistical significance to determine the independent risk factors for early recurrence after the eradicative resection of hepatocellular carcinoma.Results At the end of the 1-year follow-up period,58 patients had a recurrence,98 had no recurrence,and the recurrence rate was 37.2%,the median follow-up time was 162 days.The ROC curve showed that the area under the NLR and d-NLR was respectively 0.726 and 0.712,and the optimal point was 1.58 and 1.34.The area under the LMR curve was less than 0.5,which can not be used as predictors for early postoperative recurrence of hepatocellular carcinoma.Log-rank analysis showed that the effect of NLR and d-NLR on the survival rate of patients with hepatocellular carcinoma was statistically significant(P<0.05).Single factor COX regression model showed that the high NLR,high d-NLR,tumor diameter,vascular invasion and preoperative high AFP were the risk factors for early postoperative recurrence of hepatocellular carcinoma.The multiple fa

关 键 词：肝细胞癌 中性粒细胞/淋巴细胞 派生中性粒细胞/淋巴细胞 早期复发 危险因素 

分 类 号：R735.7[医药卫生—肿瘤]