碱性磷酸酶和淋巴细胞比值在评估BCLC分级A-B级肝癌患者TACE术后生存情况的应用价值  

Application value of alkaline phosphatase and lymphocyte ratio in evaluating the survival of hepatocellular carcinoma patients with BCLC grade A-B after TACE

作　　者：朱汉平[1] 谢栩硕[2] 彭亮[3] 梁增伟[2] 曾文铤[2] 王鹏[1] ZHU Hanping;XIE Xushuo;PENG Liang;LIANG Zengwei;ZENG Wenting;WANG Peng(Department of Traditional Chinese Medicine,the First Affiliated Hospital of Guangzhou Medical University,Guangdong Guangzhou 510120,China;Department of Infectious Medicine,the First Affiliated Hospital of Guangzhou Medical University,Guangdong Guangzhou 510120,China;Department of Gastroenterology,the First Affiliated Hospital of Guangzhou Medical University,Guangdong Guangzhou 510120,China)

机构地区：[1]广州医科大学附属第一医院中医科,广东广州510120 [2]广州医科大学附属第一医院感染内科,广东广州510120 [3]广州医科大学附属第一医院消化内科,广东广州510120

出　　处：《现代肿瘤医学》2023年第3期485-489,共5页Journal of Modern Oncology

基　　金：广东省自然科学基金(编号:2018A030313970);广东省广州市卫生和计划生育科技项目(编号:20192A011014)。

摘　　要：目的:探讨碱性磷酸酶和淋巴细胞比值(ALR)在预测巴塞罗那(BCLC)分级A-B级肝癌患者肝动脉灌注化疗栓塞术(TACE)术后生存情况的价值。方法:以肝癌TACE术后肿瘤进展或死亡为状态变量,分别以中性粒细胞和淋巴细胞比值、淋巴细胞和单核细胞比值、碱性磷酸酶、淋巴细胞计数以及ALR作为检验变量,进行两者的ROC分析,根据术前ALR预测肝癌患者TACE术后肿瘤进展或死亡的最佳诊断截点将所有纳入患者分为A组和B组,对两组肝癌患者通过倾向性评分匹配法进行配对分组,通过logistic回归估计倾向性评分值,检验匹配后两组临床病理指标的均衡性,匹配后标准差异绝对值均控制在0.10以内,Kaplan-Meier生存分析分别比较匹配后A组和B组两组肝癌患者TACE术后无进展生存率和总生存率,采用Cox回归分析评价匹配前后ALR对肝癌患者TACE术后PFS和OS的预测价值。结果:根据ALR最佳诊断截点将纳入所有患者分为ALR<5.4×10^(-7)(A组)和ALR≥5.4×10^(-7)(B组),通过倾向性评分匹配,两组共57对匹配成功,匹配前两组间有显著性差异的临床指标经匹配后均达到平衡,其他无显著性差异的指标均衡性也得到了明显的提高,Kaplan-Meier生存分析显示,匹配后A组肝癌患者TACE术后1年、2年、3年无进展生存率显著高于B组(60.5%、41.2%、33.6%vs 47.9%、20.9%、20.9%,P<0.05),A组肝癌患者TACE术后1年、2年、3年总生存率显著高于B组(72.3%、62.4%、55.2%vs 63.5%、51.5%、31.8%,P<0.05),Cox回归分析显示,匹配前后ALR均为肝癌患者TACE术后PFS和OS的独立预测因素。结论:术前ALR水平预测BCLC分级A-B级肝癌患者TACE术后远期生存情况具有较高的价值。Objective:To investigate the value of alkaline phosphatase and lymphocyte ratio(ALR)in predicting the survival of hepatocellular carcinoma(HCC)patients with BCLC grade A-B after TACE.Methods:Taking the tumor progression or death after TACE as the state variable and neutrophil to lymphocyte ratio,lymphocyte to mono-cyte ratio,alkaline phosphatase(ALP),lymphocyte count and ALR as the test variables,ROC analysis was carried out.All patients were divided into group A and group B according to the best diagnostic cut-off point of preoperative ALR to predict the tumor progression or death after TACE,the patients in the two groups were paired by propensity score matching method,and the propensity score was estimated by logistic regression,the balance of clinicopathologi-cal indexes between the two groups was tested,and the absolute value of standard difference was controlled within 0.10,Kaplan-Meier survival analysis was used to compare the progression free survival(PFS)and overall survival(OS)of HCC patients after TACE between group A and group B.Cox regression analysis was used to evaluate the effect of ALR on PFS and OS of HCC patients after TACE.Results:According to the mean value of ALR,all patients were divided into ALR<5.4×10^(-7)(group A)and ALR≥5.4×10^(-7)(group B),through propensity score matching,a total of 57 pairs of patients in the two groups were successfully matched,before matching,the clinical indicators with significant differences between the two groups were balanced,and the balance of other indicators without significant differences was also significantly improved.Kaplan-Meier survival analysis showed that after matching,the 1-year,2-year and 3-year progression free survival rates in group A were significantly higher than those in group B(60.5%,41.2%,33.6%vs 47.9%,20.9%,20.9%,P<0.05).The 1-year,2-year and 3-year over-all survival rates in group A were significantly higher than those in group B(72.3%,62.4%,55.2%vs 63.5%,51.5%,31.8%,P<0.05),ALR before and after matching were independent predictors o

关 键 词：碱性磷酸酶 淋巴细胞 肝癌 倾向性评分匹配法 Kaplan-Meier生存分析 

分 类 号：R735.7[医药卫生—肿瘤]