原发性肝癌放疗期间外周血淋巴细胞减少与预后关系的研究  

STUDY ON THE RELATIONSHIP BETWEEN THE DECREASE OF PERIPHERAL BLOOD LYMPHOCYTES AND PROGNOSIS DURING RADIOTHERAPY OF PRIMARY LIVER CANCER

作　　者：吴晓庆 万红[2] 杨璞叶 钱宏波 靳稳妮 兰琳 Wu Xiaoqing;Wan Hong;Yang Puye(The Eighth Hospital of Xi'an,Xi'an 710061,China)

机构地区：[1]陕西省西安市第八医院,710061 [2]兰州市第二人民医院

出　　处：《中国煤炭工业医学杂志》2020年第4期395-399,共5页Chinese Journal of Coal Industry Medicine

基　　金：陕西省社会发展科技攻关项目(编号:2018SF-165)。

摘　　要：目的研究外周血淋巴细胞减少与原发性肝癌患者预后的关系。方法回顾性分析我院2016年1月—2018年2月75例原发性肝癌患者临床资料,收集放疗开始前患者的临床和实验数据,包括患者性别、年龄、肿瘤分期、血液学检测指标和甲胎蛋白(AFP)水平,放疗前1周及放疗期间每周检测患者外周血淋巴细胞计数。采用统计软件SPSS 22.0进行数据分析,采用卡方检验分析外周血淋巴细胞计数与肝癌患者临床病理特征的关系。应用受试者工作特征(ROC)曲线用来计算在Cox回归分析中对患者预后有统计学意义的变量的最佳阈值。生存分析采用Kaplan-Meier和Log-rank检验,预后分析采用Cox单因素、多因素回归模型。结果根据ROC曲线分析的外周血淋巴细胞绝对值的最低值(Min ALC值)将所有患者分为二组:低Min ALC组(≤435 cells/μl)(n=46)和高Min ALC组(>435cells/μl)(n=29)。高Min ALC组与低Min ALC组间的BCLC分期和NLR比较,差异有统计学意义(P=0.043,P=0.035),高Min ALC组与低Min ALC组间的性别、年龄、肿瘤直径、Child-Pugh分级、KPS评分、AFP水平比较,差异均无统计学意义(均P>0.05)。单因素分析结果显示:肿瘤直径≥5cm、Child-Pugh B级、BCLC B、C期、NLR>3、Min ALC≤435cells/μl及AFP≥400ng/ml是影响预后的危险因素;多因素分析结果显示:放疗过程中Min ALC≤435cells/μl、BCLC B、C期、AFP≥400ng/ml是影响患者生存的独立危险因素。结论Min ALC是一种基于免疫的预后标志物,可作为肝癌患者接受放射治疗的预后因素。Objective To study the relationship between peripheral blood lymphopenia and the prognosis of patients with primary liver cancer.Methods Clinical data of seventy-five primary liver cancer patients in TheEighth Hospital of Xi′an from January 2016 to February 2018 were collected.Detailed clinical and experimental data were collected before radiotherapy,including gender,age,tumor stage,hematological indicators and AFP level.The peripheral blood lymphocyte counts of patients were measured 1 week before radiotherapy and weekly during radiotherapy.Statistical software SPSS 22.0 was used to analyze the data.Chi-square test was used to analyze the relationship between peripheral blood lymphocyte count and clinicopathological characteristics of patients with hepatocellular carcinoma.The receiver operating characteristic(ROC)curve was used to calculate the optimal threshold of variables with statistical significance for patients′prognosis in Cox regression analysis.Kaplan-Meier and Log-rank tests were used for survival analysis,and Cox single-factor and multi-factor regression models were used for prognosis analysis.Results According to the Min ALC value of ROC curve analysis,all patients were divided into two groups:low Min ALC group(≤435 cells/mul)(n=46)and high Min ALC group(>435 cells/mul)(n=29).The differences in BCLC stage and NLR between high Min ALC group and low Min ALC group were statistically significant(P=0.043,P=0.035).There were no significant differences in gender,age,tumor diameter,Child-Pugh classification,KPS score,and AFP level between the two groups(all P>0.05).Univariate analysis showed that the prognostic risk factors were tumor diameter≥5 cm,Child-Pugh B grade,BCLC B、C stage,NLR>3,Min ALC≤435 cells/μl,AFP≥400 ng/ml.Multivariate analysis showed that Min ALC<435 cells/μl,BCLC B、C stage and AFP≥400 ng/ml were the independent risk factors affecting the survival of patients during radiotherapy.Conclusion Min ALC is an immune-based prognostic marker that can be used as a prognostic fact

关 键 词：原发性肝癌 淋巴细胞 外周血淋巴细胞绝对值的最低值 预后 

分 类 号：R735[医药卫生—肿瘤]