术前GLR水平对肝细胞癌肝移植受者术后肿瘤复发的预测价值  

Predictive value of preoperative GLR levels for postoperative tumor recurrence in liver transplant recipients with liver cancer

作　　者：吴小雅 杨程凯 蔡秋程 刘建勇 吕立志 江艺 Wu Xiaoya;Yang Chengkai;Cai Qiucheng;Liu Jianyong;Lyu Lizhi;Jiang Yi(Dongfang Hospital Affiliated to Xiamen University,School of Medicine,Xiamen University,Fuzhou 350025,China;Department of Hepatobiliary Surgery,900 Hospital of The Joint Logistics Team,Fuzhou 350025,China)

机构地区：[1]厦门大学附属东方医院、厦门大学,福州350025 [2]解放军联勤保障部第九OO医院肝胆外科,福州350025

出　　处：《中华肝脏病杂志》2024年第7期657-664,共8页Chinese Journal of Hepatology

基　　金：福建省自然科学基金(2020Y0078);联勤保障部队院内课题学科支撑项目(2023XKYZ02)。

摘　　要：目的探讨术前γ-谷氨酰转移酶/淋巴细胞计数比值(GLR)水平对肝细胞癌肝移植受者术后肿瘤复发的预测价值。方法回顾性分析2008年1月至2022年10月于解放军联勤保障部第九OO医院确诊为肝细胞癌并接受肝移植治疗的158例受者的临床资料。通过X-tile软件、Kaplan-Meier法、单因素回归和多因素Cox回归分析等统计学方法,分析术前GLR水平对肝细胞癌肝移植受者术后肿瘤复发的预测价值和肝癌患者行肝移植术后肿瘤复发的危险因素。结果用X-tile软件分析确定术前GLR水平预测复发的最佳截断值为96.8。以GLR截断值96.8为界值分组进行生存分析,结果显示低水平GLR组(90例)和高水平GLR组(68例)术后1、3、5年肿瘤复发率分别为(19.3%比44.2%、31.8%比60.0%、34.1%比62.9%),2组比较,差异有统计学意义(P值均<0.05);Kaplan-Meier生存曲线分析结果显示高水平GLR组术后总生存率和无复发生存率均明显低于低水平GLR组(P值均<0.05)。单因素Cox分析结果显示,2组在术前天冬氨酸转氨酶、甲胎蛋白、手术时间、单个肿瘤最大直径、有无微血管侵犯、有无门静脉癌栓和术前GLR水平差异有统计学意义(P值均<0.05);多因素分析Cox分析结果显示,术前甲胎蛋白≥400 ng/ml、GLR≥96.8、单个肿瘤最大直径≥5.0 cm是肝细胞癌肝移植受者术后肿瘤复发的独立危险因素(P值均<0.05)。结论GLR水平对肝细胞癌肝移植受者术后肿瘤复发具有一定预测价值,当肝细胞癌肝移植受者术前GLR水平≥96.8时,术后肿瘤复发率相对较高。ObjectiveTo investigate the predictive value of preoperativeγ-glutamyl transferase/lymphocyte count ratio(GLR)levels for postoperative tumor recurrence in liver transplant recipients with liver cancer.MethodsThe clinical data of 158 recipients who were diagnosed with hepatocellular carcinoma(hereinafter referred to as liver cancer)and received liver transplantation at the No.900 Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from January 2008 to October 2022 were retrospectively analyzed.X-tile software,the Kaplan-Meier method,univariate and multivariate Cox regression,and other statistical methods were performed.The predictive value of preoperative GLR levels for postoperative tumor recurrence in liver transplant recipients with liver cancer and the risk factors for tumor recurrence in liver cancer patients post-liver transplantation were analyzed.ResultsThe X-tile software analysis confirmed that 96.8 was the optimal cutoff value for the preoperative GLR level to predict recurrence.The grouping threshold for survival analysis using the GLR cutoff value was 96.8.The tumor recurrence rates at 1,3,and 5 years after surgery in the low-level GLR group(90 cases)and the high-level GLR group were 19.3%vs.44.2%,31.8%vs.60.0%,and 34.1%vs.62.9%(68 cases),respectively,and the differences were statistically significant between the two groups(P<0.05).The Kaplan-Meier survival curve analysis results showed that the overall postoperative survival rate and recurrence-free survival rate were significantly lower in the high-level GLR group than the low-level GLR group(P<0.05).The univariate Cox analysis result showed that there were statistically significant differences in preoperative aspartate aminotransferase,alpha fetoprotein,surgery time,maximum diameter of a solitary tumor,presence or absence of microvascular invasion,presence or absence of portal vein tumor thrombus,and preoperative GLR levels between the two groups(P<0.05).Multivariate Cox analysis results showed that preoperative a

关 键 词：肝细胞癌 γ-谷氨酰胺转移酶/淋巴细胞计数比值 肝移植 复发 诊断 

分 类 号：R735.7[医药卫生—肿瘤]