γ-谷氨酰转移酶与淋巴细胞比值对慢性乙型病毒性肝炎相关肝细胞癌根治性切除术后预后的预测价值  

Prognostic value ofγ-glutamyltransferase-to-lymphocyte ratio in patients with hepatocellular carcinoma associated with chronic viral hepatitis B after radical resection

作　　者：黄海鑫 王若璇 钟犁犁 HUANG Haixin;WANG Ruoxuan;ZHONG Lili(Department of Hepatobiliary Pancreatic Vascular Surgery,The Second Affiliated Hospital of Chengdu Medical College(China National Nuclear Corporation 416 Hospital),Chengdu 610057,P.R.China;First Department of Internal Medicine,Sichuan Jiaotong Hospital,Chengdu 610097,P.R.China)

机构地区：[1]成都医学院第二附属医院·核工业四一六医院肝胆胰血管外科,成都610057 [2]四川省交通医院内一科,成都610097

出　　处：《中国普外基础与临床杂志》2023年第8期951-957,共7页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨血清γ-谷氨酰转移酶与淋巴细胞比值(gamma-glutamyltransferase-to-lymphocyte ratio,GLR)对慢性乙肝病毒(hepatitis B virus,HBV)感染相关肝细胞癌(hepatocellular carcinoma,HCC)患者行根治性切除术后预后的预测价值。方法回顾性收集2012年1月至2022年12月期间于成都医学院第二附属医院·核工业四一六医院行根治性肝癌切除术治疗的196例HBV-HCC患者的临床资料,采用log-rank检验和Cox比例风险回归探索无复发生存期(relapse-free survival,RFS)及总生存期(overall survival,OS)的影响因素,同时采用受试者操作特征(receiver operating characteristic,ROC)曲线评估GLR对HBV-HCC患者OS和RFS的预测价值。结果高GLR组术前中国肝癌分期方案(China liver cancer staging,CNLC)分期为Ⅲ期、门静脉癌栓、AFP≥400 ng/mL及低肿瘤分化程度的患者占比更高(P<0.05);低GLR组的OS和RFS情况均优于高GPR组(χ^(2)=10.071,P=0.002;χ^(2)=32.552,P<0.001)。多因素Cox比例风险回归分析结果显示,最大肿瘤直径大(HR=1.099,P=0.009)、GLR>182.31(≤182.31比>182.31,HR=0.211,P<0.001)以及肿瘤低分化程度(高+中比低,HR=0.182,P<0.001)是HBV-HCC患者术后OS缩短的危险因素,其联合预测术后预测OS的曲线下面积(area under curve,AUC)为0.930[95%CI(0.884,0.977)]。术前合并门静脉癌栓(无比有,HR=0.404,P=0.002)和GLR>182.31(≤182.31比>182.31,HR=0.435,P=0.001)是影响RFS的危险因素,其联合预测术后RFS的AUC为0.729[95%CI(0.654,0.805)]。结论本研究结果初步表明GLR与HBV-HCC患者的术后预后有关,且GLR联合最大肿瘤直径和肿瘤分化程度对OS的预测具有一定价值。Objective To investigate the prognostic value of serum gamma-glutamyltransferase-to-lymphocyte ratio(GLR)in patients with chronic hepatitis B virus(HBV)-associated hepatocellular carcinoma(HCC)after radical resection.Methods The clinical data of HBV-HCC patients diagnosed and treated with radical hepatectomy in the Second Affiliated Hospital of Chengdu Medical College(China National Nuclear Corporation 416 Hospital)from January 2012 to December 2022 were retrospectively collected and analyzed.Log-rank and multivariate Cox proportional hazard model were performed to analyze the risk factors affecting overall postoperative survival(OS)and relapse-free survival(RFS)of HBV-HCC patients,and receiver operating characteristic(ROC)curve was used to evaluate the predictive value of GLR for OS and RFS of HBV-HCC patients.Results A total of 196 eligible HBV-HCC patients underwent radical hepatectomy were included.The optimal cutoff value of GLR was 182.31 through ROC curve,and 144 cases were in low GLR group and 52 cases in high GLR group.Compared with the low GLR group,ratios of preoperative portal vein tumor thrombus,China liver cancer staging(CNLC)stageⅢ,preoperative AFP level≥400 ng/mL and low tumor differentiation were higher in the high GLR group(χ^(2)=10.071,P=0.002;χ^(2)=32.552,P<0.001).Cox proportional hazard model showed that higher maximum tumor diameter(HR=1.099,P=0.009),GLR>182.31(≤182.31 vs.>182.31,HR=0.211,P<0.001)and low tumor differentiation grade(high+moderate vs.low,HR=0.182,P<0.001)were risk factors for postoperative OS of HBVHCC patients,and the area under curve(AUC)of these risk factor for predicting OS of HBV-HCC patients was 0.930[95%CI(0.884,0.977)].Preoperative portal vein tumor thrombus(No vs.Yes,HR=0.404,P=0.002)and GLR>182.31(≤182.31 vs.>182.31,HR=0.435,P=0.001)were risk factors for postoperative RFS of HBV-HCC patients,and the AUC of these risk factor for predicting RFS was 0.729[95%CI(0.654,0.805)].Conclusion This study preliminarily indicates that GLR is associated with postoperativ

关 键 词：肝细胞癌 乙肝病毒 γ-谷氨酰转移酶-淋巴细胞比值 预后 

分 类 号：R735.7[医药卫生—肿瘤] R512.62[医药卫生—临床医学]