白蛋白-碱性磷酸酶比值在肝细胞癌患者中的预后价值  

Prognostic value of albumin to alkaline phosphatase ratio for hepatocellular carcinoma patients

作　　者：仇卫民[1] 张云燕[1] 汤小利[1] QIU Wei-min;ZHANG Yunyan;TANG Xiao-li(Department of Laboratory Medicine,Lianyungang First People's Hospital,Lianyungang 222061,China)

机构地区：[1]连云港市第一人民医院检验科,连云港222061

出　　处：《肝胆外科杂志》2023年第3期196-201,共6页Journal of Hepatobiliary Surgery

基　　金：2020年省重点研发计划(社会发展)专项资金项目(BE2020752)。

摘　　要：目的技探讨白蛋白-碱性磷酸酶比值(albumin to alkaline phosphatase ratio,AAPR)对肝细胞癌(hepatocellular carcinoma,HCC)患者远期预后的预测价值。方法本研究共纳人124例自2015年06月至2019年02月间于我院收治并接受根治性手术切除的HCC患者,回顾性收集患者的临床病理资料、术前1周的血生化指标及随访生存数据。以0.4作为AAPR的临界值,将病人分为AAPR≤0.4(n=80)和AAPR>0.4(n=44)两组,分析AAPR与HCC患者临床病理特征及预后的关系。通过Cox风险比例回归模型(LR向前法)评估AAPR在HCC患者中的独立预后价值。结果果AAPR与肿瘤大小(X^(2)=10.390,P=0.001)、TNM分期(X^(2)=16.809,P<0.001)、BCLC临床分期(X^(2)=25.279,P<0.001)、术前血清AFP水平(X^(2)=8.033,P=0.005)、血管侵犯(X^(2)=16.086,P<0.001)及预后营养指数(prognostic nutritional index,PNI)(X^(2)=5.880,P=0.015)显著相关。Kaplan-Meier生存曲线表明AAPR≤0.4组与AAPR>0.4组患者的3年总体生存率分别为13.3%与64.3%,差异具有统计学意义(X^(2)=23.538,P<0.001),低AAPR提示HCC患者预后不佳。多因素分析的结果表明肿瘤直径≥5cm(HR:4.127,95%CI:1.089~15.638,P=0.037)TNMⅡ期(风险比HR:5.479,95%置信区间:1.099~27.327,P=0.038)、术前血清AFP≥400ng/mL(风险比HR:2.132,95%置信区间:1.327~3.423,P=0.002)、NLR≥2.2(风险比HR:1.716,95%置信区间:1.007~2.924,P=0.047)及AAPR≤0.4(风险比HR:1.901,95%置信区间:1.028~3.515,P=0.040)是HCC患者预后不佳的独立预测因素。结论仑AAPR是评估HCC患者预后的一项有价值的生物标志物,低AAPR提示患者预后不佳。Objective To evaluate the predictive value of albumin to alkaline phosphatase ratio(AAPR)for long-term survival of hepatocellular carcinoma(HCC)patients.Methods A total of 124 HCC patients who underwent curative resection in our institution from June 2015 to February 2019 were included in this study.The clinicopathological data,preoperative laboratory test within one week and follow-up information of all patients were retrospectively collected.124 patients were divided into low AAPR(n=80)and high AAPR group(n=44)based on the threshold value of 0.4 The relationships between AAPR and clinicopathological features as well as the prognosis of HCC patients were analyzed.Moreover,the independent prognostic significance of AAPR for HCC patients was further determined by the multivariate Cox proportional hazards regression model(LR).Results The results showed that low AAPR was significantly correlated with tumor size(X^(2)=10.390,P=0.001),TNM stage(x=16.809,P<0.001),BCLC clinical stage(X^(2)=25.279,P<0.001),preoperative serum AFP level(X^(2)=8.033,P=0.005),vascular invasion(X^(2)=16.086,P<0.001)and prognostic nutritional index(PNI)(X^(2)=5.880,P=0.015).Kaplan-Meier survival curves demonstrated that the 3-year overall survival of HCC patients with AAPR≤0.4 and AAPR>0.4 was 13.3%and 64.3%,respectively,with a significantly statistical difference(X^(2)=23.538,P<0.001).Low AAPR was an indicator of poor prognosis of HCC patients.The results of the multivariate COX regression analysis revealed that tumor diameter≥5 cm(HR:4.127,confidence interval[CI]:1.089~15.638,P=0.037),TNM stage II(HR:5.479,95%CI:1.099~27.327,P=0.038),preoperative serum AFP≥400 ng/ml(HR:2.132,95%CI:1.327~3.423,P=0.002),NLR≥2.2(HR:1.716,95%CI:1.007~2.924,P=0.047)and AAPR≤0.4(HR:1.901,95%CI:1.028~3.515,P=0.040)were independent predictors of poor prognosis in HCC patients.Conclusion Albumin to alkaline phosphatase ratio(AAPR)is a valuable predictor of prognostic assessment for HCC patients,and low AAPR was markedly associated with poor OS.

关 键 词：肝细胞癌 白蛋白一碱性磷酸酶比值 预后 

分 类 号：R735.7[医药卫生—肿瘤]