经导管动脉化疗栓塞术后肝细胞癌患者中性粒细胞与淋巴细胞比值的预后意义
Prognostic significance of neutrophil to lymphocyte ratio in patients with hepatocellular carcinoma after transcatheter arterial chemoembolization.
作者信息
Xu Xinsen, Chen Wei, Zhang Lingqiang, Miao Runchen, Zhou Yanyan, Wan Yong, Dong Yafeng, Liu Chang
机构信息
Department of Hepatobiliary Surgery, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China.
Department of Obstetrics and Gynecology, University of Kansas School of Medicine, Kansas 66160, USA.
出版信息
Chin Med J (Engl). 2014;127(24):4204-9.
BACKGROUND
Accumulating evidence indicates that systemic inflammation response is associated with the prognosis of various cancers. The aim of this study was to investigate the neutrophil-lymphocyte ratio (NLR), which is one of the systemic inflammation markers, in the prognosis of hepatocellular carcinoma (HCC) after treatment of transcatheter arterial chemoembolization (TACE).
METHODS
The clinical data of 178 HCC patients who received TACE were retrospectively analyzed. The optimal NLR cutoff was determined according to the receiver operating characteristic (ROC) analysis. All patients were divided into NLR-normal group and NLR-elevated group according to the cutoff, and the clinical features of these two groups were comparatively analyzed. Meanwhile, the overall survival and disease free survival (DFS) were analyzed using the Kaplan-Meier method. The risk factors of postoperative survival were investigated using univariate and multivariate Cox regression analyses.
RESULTS
The optimal NLR cutoff was defined at 1.85 and 42 (23.6%) patients had an elevated NLR (NLR>1.85). The median survival time was 9.5 months (range 1-99 months). The clinical data between the two groups were comparable, except for a-fetoprotein. Follow-up results showed that the median survival of patients with normal NLR was 17.5 months (range: 1-99 months) compared with 8 months (range: 8-68 months) of patients with elevated NLR. The 1, 3 and 5-year overall survival of patients in the NLR-normal group and NLR-elevated group were 57.3%, 44.1%, and 27.2% and 42.1%, 19.6%, and 9.5% respectively (χ(2) = 194.2, P < 0.001). Similarly, the disease free survival also has a significant difference (χ(2) = 39.3, P < 0.001). Multivariate Cox regression analysis showed that a high NLR was an independent factor affecting the survival rate of HCC after TACE (P = 0.04).
CONCLUSION
Preoperative NLR was an important prognostic factor to predict the prognosis of patients with intermediate HCC treated with TACE.
背景
越来越多的证据表明，全身炎症反应与多种癌症的预后相关。本研究旨在探讨中性粒细胞与淋巴细胞比值（NLR）这一全身炎症标志物之一，在经动脉化疗栓塞术（TACE）治疗后肝细胞癌（HCC）预后中的作用。
方法
回顾性分析178例接受TACE治疗的HCC患者的临床资料。根据受试者工作特征（ROC）分析确定最佳NLR临界值。根据该临界值将所有患者分为NLR正常组和NLR升高组，并对两组的临床特征进行比较分析。同时，采用Kaplan-Meier法分析总生存期和无病生存期（DFS）。采用单因素和多因素Cox回归分析探讨术后生存的危险因素。
结果
最佳NLR临界值定义为1.85，42例（23.6%）患者NLR升高（NLR>1.85）。中位生存时间为9.5个月（范围1 - 99个月）。除甲胎蛋白外，两组间的临床资料具有可比性。随访结果显示，NLR正常患者的中位生存期为17.5个月（范围：1 - 99个月），而NLR升高患者为8个月（范围：8 - 68个月）。NLR正常组和NLR升高组患者的1、3和5年总生存率分别为57.3%、44.1%和27.2%以及42.1%、19.6%和9.5%（χ(2)=194.2，P<0.001）。同样，无病生存期也有显著差异（χ(2)=39.3，P<0.001）。多因素Cox回归分析显示，高NLR是影响TACE术后HCC患者生存率的独立因素（P = 0.04）。
结论
术前NLR是预测TACE治疗的中期HCC患者预后的重要预后因素。
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