基于中性粒细胞与淋巴细胞比值的评分模型预测乙肝相关性肝细胞癌肝移植术后复发。
A scoring model based on neutrophil to lymphocyte ratio predicts recurrence of HBV-associated hepatocellular carcinoma after liver transplantation.
机构信息
Liver Transplantation Center, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
出版信息
PLoS One. 2011;6(9):e25295. doi: 10.1371/journal.pone.0025295. Epub 2011 Sep 26.
BACKGROUND
Neutrophil to lymphocyte ratio (NLR) has been proposed to predict prognosis of hepatocellular carcinoma (HCC). However, the cut-off values are empirical. We determined the optimal cut-off value to predict HCC recurrence after liver transplantation (LT) and further established a scoring model based on NLR.
METHODOLOGY/PRINCIPAL FINDINGS: We analyzed the outcome of 101 HBV-associated HCC patients undergoing LT. Preoperative risk factors for tumor recurrence were evaluated by univariate analysis. By using ROC analysis, NLR≥3 was considered elevated. The disease-free survival (DFS) and overall survival (OS) for patients with high NLR was significantly worse than that for patients with normal NLR (the 5-year DFS and OS of 28.5% and 19.5% vs. 64.9% and 61.8%, respectively; P<0.001). Univariate analysis revealed that tumor size >5 cm, tumor number >3, macrovascular invasion, AFP≥400 µg/L, NLR≥3, and HBV-DNA level >5 log10 copies/mL were preoperative predictors of DFS. Cox regression analysis showed macrovascular invasion, tumor number, and high NLR were independent prognostic factors. We then established a preoperative prognostic score based on multivariate analysis. Each factor was given a score of 1. Area under the ROC curve of the score was 0.781. All nine patients with score 3 developed recurrence within 6 months after LT. Of 71 patients without vascular invasion, three patients with both tumor number >3 and NLR≥3 developed recurrence within 14 months after LT while the 5-year DFS and OS for patients with a score of 0 or 1 were 68.1% and 62.8%, respectively.
CONCLUSIONS/SIGNIFICANCE: Preoperative elevated NLR significantly increases the risk of recurrence in patients underwent LT for HCC. Patients with both NLR≥3 and tumor number >3 are not a good indication for LT. Our score model may aid in the selection of patients that would most benefit from transplantation for HCC.
背景
中性粒细胞与淋巴细胞比值（NLR）已被提出用于预测肝细胞癌（HCC）的预后。然而，这些截断值是经验性的。我们确定了预测 HCC 患者肝移植（LT）后复发的最佳截断值，并进一步建立了基于 NLR 的评分模型。
方法/主要发现：我们分析了 101 例乙型肝炎病毒相关 HCC 患者 LT 后的结果。通过单因素分析评估了肿瘤复发的术前危险因素。通过 ROC 分析，将 NLR≥3 视为升高。NLR 升高的患者无疾病生存率（DFS）和总生存率（OS）明显低于 NLR 正常的患者（5 年 DFS 和 OS 分别为 28.5%和 19.5% vs. 64.9%和 61.8%；P<0.001）。单因素分析显示肿瘤大小>5cm、肿瘤数量>3、大血管侵犯、AFP≥400μg/L、NLR≥3 和 HBV-DNA 水平>5log10 拷贝/ml 是 DFS 的术前预测因素。Cox 回归分析显示大血管侵犯、肿瘤数量和高 NLR 是独立的预后因素。然后，我们根据多因素分析建立了术前预后评分。每个因素的评分均为 1。评分的 ROC 曲线下面积为 0.781。评分 3 分的 9 例患者在 LT 后 6 个月内均发生复发。在 71 例无血管侵犯的患者中，3 例肿瘤数量>3 且 NLR≥3 的患者在 LT 后 14 个月内复发，而评分 0 或 1 的患者 5 年 DFS 和 OS 分别为 68.1%和 62.8%。
结论/意义：术前 NLR 升高显著增加了 HCC 患者 LT 后复发的风险。NLR≥3 且肿瘤数量>3 的患者不适合 LT。我们的评分模型可能有助于选择最受益于 HCC 移植的患者。
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