术前血小板-白蛋白评分对肝硬化肝癌术后预后的预测价值  

Predictive value of preoperative platelet-albumin score for postoperative prognosis of cirrhotic hepatocellular carcinoma patients

作　　者：李勇[1] 兰川[1] 吴斌[1] 张光年[1] 李敬东[1] Li Yong;Lan Chuan;Wu Bin;Zhang Guangnian;Li Jingdong(Department of Hepatobiliary Surgery,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China)

机构地区：[1]川北医学院附属医院肝胆外科,四川省南充市637000

出　　处：《中华肝脏外科手术学电子杂志》2023年第4期412-416,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：四川省卫生健康委员会普及应用项目(20PJ150)。

摘　　要：目的探讨术前血小板-白蛋白(PAL)评分对肝硬化肝细胞癌(肝癌)患者术后预测价值。方法回顾性分析2016年1月至2022年1月在川北医学院附属医院行肝切除术的171例肝硬化肝癌患者临床资料。其中男145例,女26例;年龄24~78岁,中位年龄50岁。患者均合并乙型病毒性肝炎。患者均签署知情同意书,符合医学伦理学规定。根据PAL评分患者分为PALⅠ组(101例)和PALⅡ-Ⅲ组(70例)。两组术前PAL评分比较采用t检验。两组肝切除术后肝衰竭(PHLF)发生率、围手术期死亡率比较采用χ^(2)检验。采用ROC曲线分析PAL评分对PHLF、围手术期死亡的预测价值。生存分析采用Kaplan-Meier法和Log-Rank检验。结果PALⅠ组术前PAL评分为(-4.07±0.20)分,明显低于PALⅡ-Ⅲ组的(-3.45±0.31)分(t=-15.589,P<0.05)。PALⅠ、Ⅱ、Ⅲ级患者发生PHLF分别为9、15、7例,围手术期死亡相应为1、5、2例。PALⅡ-Ⅲ组PHLF发生率为31%(22/70),明显高于PALⅠ组的9%(9/101)(χ^(2)=14.125,P<0.05);围手术期死亡率为10%(7/70),亦明显高于PALⅠ组的1%(1/101)(χ^(2)=5.641,P<0.05);随着PAL等级越高,发生PHLF的风险越大,围手术期死亡率也越高(χ^(2)=23.246,9.485;P<0.05)。PAL评分预测PHLF和围手术期死亡的ROC曲线下面积(AUC)分别为0.712、0.768,Child-Pugh分级预测相应为0.617、0.645,两个模型预测PHLF和围手术期死亡的AUC差异无统计学意义(Z=1.380,1.235;P>0.05)。PALⅠ组术后1、3、5年累积生存率分别为84.6%、55.6%、34.6%,PALⅡ-Ⅲ组相应为75.2%、40.5%、27.7%,PALⅠ组术后总体生存优于PALⅡ-Ⅲ组(χ^(2)=5.698,P<0.05)。结论PAL评分对肝硬化肝癌患者术后肝衰竭、围手术期死亡及远期预后有一定的预测价值,具有与Child-Pugh分级系统相当的效能。Objective To evaluate the predictive value of preoperative platelet-albumin(PAL)score for the postoperative prognosis of patients with cirrhotic hepatocellular carcinoma(HCC).Methods Clinical data of 171 HCC patients with cirrhotic HCC who underwent hepatectomy in the Affiliated Hospital of North Sichuan Medical College from January,2016 to January,2022 were retrospectively analyzed.Among them,145 patients were male and 26 female,aged from 24 to 78 years,with a median age of 50 years.All patients were complicated with hepatitis B.The informed consents of all patients were obtained and the local ethical committee approval was received.According to PAL score,all patients were divided into the PALⅠgroup(n=101)and PALⅡ-Ⅲgroup(n=70).Preoperative PAL scores between two groups were compared by t test.The incidence of post-hepatectomy liver failure(PHLF)and perioperative mortality between two groups were compared by using Chi-square test.The predictive value of PAL score for PHLF and perioperative mortality was analyzed by the ROC curve.Survival analysis was performed by Kaplan-Meier method and log-rank test.Results In the PALⅠgroup,preoperative PAL score was-4.07±0.20,significantly lower than-3.45±0.31 in the PALⅡ-Ⅲgroup(t=-15.589,P<0.05).In the PALⅠ,ⅡandⅢpatients,9,15 and 7 cases developed PHLF,respectively,and 1,5 and 2 died during perioperative period.The incidence rate of PHLF in the PALⅡ-Ⅲgroup was 31%(22/70),significantly higher than 9%(9/101)in the PALⅠgroup(χ^(2)=14.125,P<0.05).Perioperative mortality was 10%(7/70)in the PALⅡ-Ⅲgroup,significantly higher than 1%(1/101)in the PALⅠgroup(χ^(2)=5.641,P<0.05).The higher the PAL grade,the higher the risk of PHLF and the higher the perioperative mortality(χ^(2)=23.246,9.485;P<0.05).The area under ROC curve(AUC)of PAL score in predicting PHLF and perioperative mortality was 0.712 and 0.768,and 0.617 and 0.645 for Child-Pugh score,respectively.No significant difference was observed in the AUC between two models for predicting PHLF and pe

关 键 词：血小板-白蛋白评分 癌 肝细胞 肝炎 乙型 肝硬化 肝功能衰竭 预后 

分 类 号：R735.7[医药卫生—肿瘤]