肝纤维化-4指数(FIB-4)联合预后营养指数(PNI)对早期肝癌射频消融术后复发及生存期的预测价值  

Value of fibrosis-4 combined with prognostic nutritional index in predicting recurrence and survival time after radiofrequency ablation for early-stage hepatocellular carcinoma

作　　者：张旭[1] 哈福双[1] 李凤惠[1] 高艳颖[1] 梁静[1] ZHANG Xu;HA Fushuang;LI Fenghui;GAO Yanying;LIANG Jing(Department of Gastroenterology and Hepatology,Tianjin Third Central Hospital,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases,Artificial Cell Engineering Technology Research Center,Tianjin Institute of Hepatobiliary Disease,Tianjin 300170,China)

机构地区：[1]天津市第三中心医院消化肝病科,天津市重症疾病体外生命支持重点实验室,天津市人工细胞工程技术研究中心,天津市肝胆研究所,天津300170

出　　处：《临床肝胆病杂志》2023年第11期2614-2622,共9页Journal of Clinical Hepatology

基　　金：天津市医学重点学科(专科)建设项目(TJYXZDXK-034A)。

摘　　要：目的探讨术前肝纤维化-4指数(FIB-4)联合预后营养指数(PNI)对于早期肝癌射频治疗(RFA)术后复发的预测价值。方法回顾性分析2013年1月—2017年12月于天津市第三中心医院行RFA的365例初诊为早期肝癌患者的临床资料,统计患者的复发及生存情况。以术后肿瘤复发为阳性事件绘制FIB-4、PNI的ROC曲线,选取最佳cut-off值,进行FIB-4和PNI的分级,组合为FIB-4-PNI评分,据此分为FIB-4-PNI 0分组(n=207)、1分组(n=93)和2分组(n=65)。计数资料组间比较采用χ^(2)检验。采用Kaplan-Meier生存分析及Log-rank检验分析不同FIB-4-PNI等级组无复发生存率(RFS)及总生存率(OS)的差异。采用Cox回归模型筛选影响患者RFS、OS的相关因素。结果所有患者的1、3和5年RFS率分别为79.2%、49.8%和34.3%,中位RFS为35个月,1、3和5年OS率分别为98.9%、86.9%和77.3%。不同FIB-4、PNI、FIB-4-PNI水平患者累积RFS率(χ^(2)值分别为17.890、29.826、32.397,P值均<0.001)、OS率(χ^(2)值分别为16.896、21.070、26.121,P值均<0.001)差异均有统计学意义。多因素Cox回归分析显示,糖尿病史(HR=1.418,95%CI:1.046~1.922,P=0.024),肿瘤数目2个(HR=1.516,95%CI:1.094~2.101,P=0.012)、3个(HR=2.146,95%CI:1.278~3.604,P=0.004),FIB-4-PNI1分(HR=1.875,95%CI:1.385~2.539,P<0.001)、2分(HR=2.350,95%CI:1.706~3.236,P<0.001)是RFS的独立危险因素;肿瘤数目2个(HR=1.732,95%CI:1.005~2.983,P=0.048)、3个(HR=3.511,95%CI:1.658~7.433,P=0.001),FIB-4-PNI 1分(HR=2.094,95%CI:1.230~3.565,P=0.006)、2分(HR=3.908,95%CI:2.306~6.624,P<0.001)是影响OS的独立危险因素。结论FIB-4-PNI评分可作为早期肝癌RFA术后复发及总生存期的独立预测因素,可联合肿瘤特征预测患者术后的复发及生存情况。Objective To investigate the value of preoperative fibrosis 4 score(FIB-4)combined with prognostic nutritional index(PNI)in predicting recurrence after radiofrequency ablation(RFA)for early-stage hepatocellular carcinoma(HCC).Methods A retrospective analysis was performed for the clinical data of 365 patients with the initial diagnosis of early-stage HCC who underwent RFA at Tianjin Third Central Hospital from January 2013 to December 2017,and a statistical analysis was performed for recurrence and survival.The receiver operating characteristic(ROC)curve was plotted for FIB-4 and PNI with postoperative tumor recurrence as the positive event,and their optimal cut-off values were selected.FIB-4 and PNI were graded and combined as FIB-4-PNI score,based on which the patients were divided into 0-point group with 207 patients,1-point group with 93 patients,and 2-point group with 65 patients.The chi-square test was used for comparison of categorical data between groups.The Kaplan-Meier survival analysis and the log-rank test were used to compare the recurrence-free survival(RFS)and overall survival(OS)between groups,and the Cox regression model was used to investigate the influencing factors for RFS and OS.Results The 1-,3-,and 5-year RFS rates of all patients were 79.2%,49.8%,and 34.3%,respectively,with a median RFS of 35 months,while the 1-,3-,and 5-year OS rates of all patients were 98.9%,86.9%,and 77.3%,respectively.There were significant differences in cumulative RFS and OS rates between the patients with different levels of FIB-4,PNI,and FIB-4-PNI(RFS rate:χ^(2)=17.890,29.826,and 32.397,all P<0.001;OS rate:χ^(2)=16.896,21.070,and 26.121,all P<0.001).The multivariate Cox regression analysis showed that history of diabetes(hazard ratio[HR]=1.418,95%confidence interval[CI]:1.046-1.922,P=0.024),two tumors(HR=1.516,95%CI:1.094-2.101,P=0.012),three tumors(HR=2.146,95%CI:1.278-3.604,P=0.004),FIB-4-PNI 1 point(HR=1.875,95%CI:1.385-2.539,P<0.001),and FIB-4-PNI 2 points(HR=2.35,95%CI:1.706-3.236,P<0.001)were independent r

关 键 词：癌 肝细胞 射频消融术 营养评价 预后 

分 类 号：R735.7[医药卫生—肿瘤]