术前白蛋白与碱性磷酸酶比值对肝切除术后肝细胞癌患者临床预后的评估价值  

Value of preoperative albumin-to-alkaline phosphatase ratio in evaluating the clinical prognosis of patients with hepatocellular carcinoma after hepatectomy

作　　者：陈石 周元[1] 马春阳 CHEN Shi;ZHOU Yuan;MA Chunyang(Department of Hepatobiliary and Pancreatic Surgery,Nantong Tumor Hospital,Nantong,Jiangsu 226006,China)

机构地区：[1]南通市肿瘤医院肝胆胰外科,江苏南通226006

出　　处：《现代医学与健康研究电子杂志》2023年第3期34-38,共5页Modern Medicine and Health Research

摘　　要：目的 探讨肝细胞癌(HCC)患者行肝切除术术前白蛋白与碱性磷酸酶比值(AAPR)与临床预后的关系,为临床改善HCC患者预后提供新思路。方法 回顾性分析2019年7月至2020年6月期间于南通市肿瘤医院行肝切除术的132例HCC患者的临床资料,并于术后完成2年随访,根据患者的预后情况将其分为预后不良组(68例)与预后良好组(64例)。比较两组患者术前的白蛋白、碱性磷酸酶及AAPR水平,并采用受试者工作特征(ROC)曲线分析白蛋白、碱性磷酸酶及AAPR水平对HCC患者预后的预测效能,对两组患者的一般资料进行单因素分析,并通过多因素Logistic回归模型分析,筛选出影响HCC患者预后的独立危险因素。结果 132例行肝切除术的HCC患者在随访期间共出现预后不良68例,占51.52%,其中肿瘤复发51例,淋巴结转移9例,肝内转移4例,肺转移4例;预后良好患者64例,占48.48%;预后不良组患者术前白蛋白、AAPR水平均显著低于预后良好组,碱性磷酸酶水平显著高于预后良好组;经ROC曲线分析,结果显示,白蛋白、碱性磷酸酶、AAPR预测HCC肝切除术患者预后的曲线下面积(AUC)分别为0.717、0.724、0.770,灵敏度分别为48.53%、57.35%、83.82%,特异度分别为92.19%、81.25%、65.62%,AAPR预测的AUC、灵敏度均高于白蛋白、碱性磷酸酶;经单因素分析,结果显示,预后不良组肿瘤直径≥5 cm、有微血管癌栓、术前AAPR<0.59的患者占比均显著高于预后良好组;经多因素Logisitic回归模型分析,结果显示,肿瘤直径≥5 cm、有微血管癌栓、术前AAPR<0.59均是HCC肝切除术患者术后预后不良的危险因素(OR=2.344、2.477、2.743,均P<0.05)。结论 HCC肝切除术患者术前的AAPR水平与临床预后密切相关,其对HCC肝切除术患者预后具有较高的预测价值,且肿瘤直径≥5 cm、有微血管癌栓、术前AAPR<0.59均是影响患者肝切除术后预后不良的重要危险因素,临床应予以相应的对症处理Objective To explore the relationship between the albumin-to-alkaline phosphatase ratio(AAPR) before hepatectomy and clinical prognosis in patients with hepatocellular carcinoma(HCC), and to provide a new idea for improving the prognosis of HCC patients.Methods The clinical data of 132 patients with HCC who underwent hepatectomy at Nantong Tumor Hospital from July 2019 to June 2020 were analyzed retrospectively, they were followed up for 2 years after the operation, and according to their prognosis they were divided into the poor prognosis group(68 cases) and the good prognosis group(64 cases). The levels of albumin, alkaline phosphatase and AAPR were compared between the two groups of patients before operation, and the predictive efficacy of albumin, alkaline phosphatase and AAPR on the prognosis of HCC patients was analyzed by using the receiver operating characteristic(ROC) curve, the general data of the two groups of patients were analyzed by single factor analysis, and the independent risk factors affecting the prognosis of HCC patients were screened through the analysis of multivariate Logistic regression model. Results During the follow-up period, 68 of the 132 HCC patients who underwent hepatectomy had poor prognosis, accounting for 51.52%, there were 51 cases of tumor recurrence, 9 cases of lymph node metastasis, 4 cases of intrahepatic metastasis and 4 cases of pulmonary metastasis;64 patients had good prognosis, accounting for 48.48%;preoperative albumin and AAPR levels in the poor prognosis group were significantly lower than those in the good prognosis group, while alkaline phosphatase levels were significantly higher than that in the good prognosis group;the ROC curve analysis showed that the area under curve(AUC) of albumin, alkaline phosphatase and AAPR predicting the prognosis of HCC patients after hepatectomy were 0.717, 0.724 and 0.770 respectively, the sensitivity were 48.53%,57.35% and 83.82% respectively, and the specificity were 92.19%, 81.25% and 65.62% respectively, the AUC and sensitivit

关 键 词：肝细胞癌 肝切除术 白蛋白与碱性磷酸酶比值 临床预后 

分 类 号：R735.7[医药卫生—肿瘤]