Zhang Wei, Zhao Gang, Wei Kai, Zhang Qingxiang, Ma Weiwei, Wu Qiang, Zhang Ti, Kong Dalu, Li Qiang, Song Tianqiang
Department of Hepatobiliary Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, 24 Bin Shui Road, Hexi District, Tianjin, 300060, China,
Med Oncol. 2015 Apr;32(4):107. doi: 10.1007/s12032-015-0549-3. Epub 2015 Mar 7.
Currently there is no predictor for survival after adjuvant sorafenib in patients with hepatocellular carcinoma (HCC) who have undergone curative resection. Thirty-eight patients who underwent curative resection of HCC received adjuvant sorafenib therapy between August 2009 and March 2012. Clinicopathological parameters including patient factors, tumor factors, liver background, and inflammatory factors (before surgery and dynamic changes after sorafenib therapy) were evaluated to identify predictors for overall survival (OS) and recurrence-free survival (RFS). The recurrence rate, mortality rate, and clinicopathological data were also compared. Increased NLR after sorafenib (HR = 3.199, 95 % CI 1.365-7.545, P = 0.008), increased GGT after sorafenib (HR = 3.204, 95 % CI 1.333-7.700, P = 0.009), and the presence of portal vein thrombosis (HR = 2.381, 95 % CI 1.064-5.328, P = 0.035) were risk factors related to RFS. By contrast, increased NLR after sorafenib was the only independent risk factor related to OS (HR = 4.647, 95 % CI 1.266-17.053, P = 0.021). Patients with increased NLR or increased GGT after sorafenib had a higher incidence of recurrence and death. Patients who had increased NLR tended to have higher preoperative levels of NLR and GGT. There were no differences in clinicopathological factors in patients with increased GGT and decreased GGT. In conclusion, increased NLR predicted a worse OS and RFS in patients with HCC who underwent curative resection with adjuvant sorafenib therapy. Increased GGT predicted a worse OS. NLR and GGT can be monitored dynamically before and after sorafenib therapy.
目前，对于接受根治性切除的肝细胞癌（HCC）患者，尚无预测辅助性索拉非尼治疗后生存期的指标。2009年8月至2012年3月期间，38例接受HCC根治性切除的患者接受了辅助性索拉非尼治疗。评估了包括患者因素、肿瘤因素、肝脏背景和炎症因素（手术前及索拉非尼治疗后的动态变化）在内的临床病理参数，以确定总生存期（OS）和无复发生存期（RFS）的预测指标。还比较了复发率、死亡率和临床病理数据。索拉非尼治疗后中性粒细胞与淋巴细胞比值（NLR）升高（HR = 3.199，95%CI 1.365 - 7.545，P = 0.008）、索拉非尼治疗后γ-谷氨酰转移酶（GGT）升高（HR = 3.204，95%CI 1.333 - 7.700，P = 0.009）以及存在门静脉血栓形成（HR = 2.381，95%CI 1.064 - 5.328，P = 0.035）是与RFS相关的危险因素。相比之下，索拉非尼治疗后NLR升高是与OS相关的唯一独立危险因素（HR = 4.647，95%CI 1.266 - 17.053，P = 0.021）。索拉非尼治疗后NLR升高或GGT升高的患者复发和死亡发生率更高。NLR升高的患者术前NLR和GGT水平往往更高。GGT升高和降低的患者临床病理因素无差异。总之，NLR升高预示接受根治性切除并辅助索拉非尼治疗的HCC患者OS和RFS更差。GGT升高预示OS更差。索拉非尼治疗前后可动态监测NLR和GGT。
