γ-谷氨酰转肽酶/血小板比值在肝细胞癌患者中的预后价值  

Prognostic value of gamma-glutamyl transpeptidase to platelet ratio for hepatocellular carcinoma patients

作　　者：沈洁 葛仁美 崔翔 SHEN Jie;GE Renmei;CUI Xiang(Laboratory Department of Hai'an People's Hospital Jiangsu,Hai'an 226600)

机构地区：[1]海安市人民医院检验科,海安226600

出　　处：《肝胆外科杂志》2024年第5期375-380,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(BE2020709)。

摘　　要：目的探讨γ-谷氨酰转肽酶/血小板计数比值(gamma-glutamyl transpeptidase to plateletratio,GPR)在肝细胞癌(hepatocellularcarcinoma,HCC)患者中的预后价值。方法选取2018年05月至2020年03月间于我院初诊并行手术切除的144例HCC患者作为研究对象,收集患者的临床病理资料、实验室检查及随访数据进行回顾性分析。根据受试者工作特征(Receiveroperationcharacteristics,ROC)曲线确定GPR的最佳截止点,并将所有患者分为高GPR与低GPR组。通过Kaplan-Meier生存曲线及log-rank检验比较两组患者的总体生存(Overall survival,OS)差异,并采用单、多变量Cox回归分析评估影响HCC患者预后的独立风险因素。结果ROC曲线表明术前GPR预测HCC患者总体OS的最佳截止点为0.733,曲线下面积AUC值为0.653(95%置信区间:0.563-0.742)。根据此临界值,将所有患者分为GPR≤0.733(n=61)和GPR>0.733组(n=83)。结果表明,高GPR比值(>0.733)与肿瘤直径(χ^(2)=4.383,P=0.046)、TNM分期(χ^(2)=4.177,P=0.041)及BCLC临床分期(χ^(2)=4.492,P=0.034)具有显著相关性。此外,两组患者的5年总体OS分别为61.5%与32.1%差异有统计学意义(χ^(2)=7.602,P=0.006),GPR>0.733提示HCC患者预后不佳。单、多因素分析证实微血管浸润(风险比:2.004,95%置信区间:1.140-3.526,P=0.016)、术前甲胎蛋白AFP水平(风险比:1.855,95%置信区间:1.054-3.264,P=0.032)、BCLC临床分期(风险比:2.199,95%置信区间:1.333-3.628,P=0.002)及GPR比值(风险比:2.016,95%置信区间:1.177-3.453,P=0.011)是HCC患者的独立预后因素。结论γ-谷氨酰转肽酶/血小板比值有望成为一项新的预后评价指标,为HCC患者提供准确的预后分层。Objective To determine the prognostic value of gamma-glutamyl transpeptidase,gamma-glutamyl transpeptidase to platelet ratio(GPR)for hepatocellular carcinoma(HCC)patients.Methods 144 HCC patients who were initially diagnosed and treated with surgical resection in our hospital from May 2018 to March 2020 were included,and the clinicopathological information,preoperative laboratory test and follow-up data of all patients were systematically collected to perform a retrospective analysis.The opti-mal cut-off point of GPR was identified by receiver operation characteristics(ROC)curve,and all HCC patients were divided into high GPR and low GPR groups.The Kaplan-Meier method and log rank test were used to compare the overall survival(OS)between the two groups,and the independent prognostic factors for HCC patients were determined by the univariate and multivariate Cox regression anal-ysis.Results The ROC curve indicated that the best cut-off point of preoperative GPR for predicting the OS of HCC patients was 0.733,and the value of the area under curve(AUC)was 0.653(95%confidence interval[CI]:0.563-0.742).All patients were divided into high GPR(>0.733,n=83)and low GPR group(≤0.733,n=61)based on the threshold value of 0.733.The results showed that high CPR(>0.733)was significantly associated with tumor diameter(χ^(2)=4.383,P=0.046),TNM staging(χ^(2)=4.177,P=0.041)and BCLC stage(χ^(2)=4.492,P=0.034).Furthermore,the result of survival analysis showed that the 5-year 0S rate of low and high CPR group was 61.5%and 32.1%,respectively(x?=7.602,P=0.006).High GPR(>0.733)was an indi-cator of poor OS in HCC patients.The univariate and multivariate Cox analysis demonstrated that microvascular invasion(hazard ratio[HR]:2.004,95%CI:1.140-3.526,P=0.016),preoperative AFP level(HR:1.855,95%CI:1.054-3.264,P=0.032),BCLC stage(HR:2.199,95%CI:1.333-3.628,P=0.002)and CPR ratio(HR:2.016,95%CI:1.177-3.453,P=0.011)were independent prognostic factors for HCC patients.Conclusion Gamma-glutamyl transpeptidase to platelet ratio(GPR)was a no-vel

关 键 词：肝细胞癌 Γ-谷氨酰转肽酶 γ-谷氨酰转肽酶/血小板比值 预后 预测 

分 类 号：R659[医药卫生—外科学]