He Chao, Peng Wei, Li Chuan, Wen Tian-Fu
Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China.
Medicine (Baltimore). 2017 Nov;96(45):e8540. doi: 10.1097/MD.0000000000008540.
Elevated preoperative aspartate aminotransferase (AST) to lymphocyte ratio index (ALRI) is reported to be a prognostic factor for patients with hepatocellular carcinoma (HCC) after treatment. However, [DELTA] ALRI which represents the change from postoperative ALRI to preoperative ALRI change has received little attention. The present study was designed to evaluate the prognostic value of [DELTA] ALRI in small HCC patients after liver resection.A retrospective cohort study was performed to analyze 241 patients with small HCC who underwent liver resection. Patients were divided into Group A ([DELTA] ALRI < 0, n = 142) and group B ([DELTA] ALRI ≥ 0, n = 99) according to postoperative ALRI change. Clinical data, overall survival (OS), and recurrence-free survival (RFS) were compared between the 2 groups, and a multivariate analysis was used to identify prognostic factors.The 1, 3, and 5-year OS rates were 96.5%, 84.9%, and 70.8%, respectively, for group A, and 94.9%, 75.8%, and 59.7%, respectively for group B (P = .014). The corresponding 1, 3, and 5-year RFS rates were 78.2%, 54.6%, and 52.3%, respectively, for group A, and 62.6%, 40.1%, 24.5%, respectively, for group B (P < .001). The results of univariate and multivariate analysis indicated that [DELTA] ALRI was an independent prognostic factor for both RFS (P < .001, hazard ratio [HR] 2.192, 95% confidence interval 1.527-3.147) and OS (P < .001, HR 2.381, 95% confidence interval 1.503-3.771).A positive [DELTA] ALRI after liver resection predicts decreased OS and RFS in patients with small HCC.
据报道，术前天冬氨酸转氨酶（AST）与淋巴细胞比率指数（ALRI）升高是肝细胞癌（HCC）患者治疗后的一个预后因素。然而，代表术后ALRI相对于术前ALRI变化的ΔALRI很少受到关注。本研究旨在评估ΔALRI在小肝癌患者肝切除术后的预后价值。
进行了一项回顾性队列研究，分析了241例行肝切除的小肝癌患者。根据术后ALRI变化将患者分为A组（ΔALRI < 0，n = 142）和B组（ΔALRI≥0，n = 99）。比较两组的临床资料、总生存期（OS）和无复发生存期（RFS），并采用多因素分析确定预后因素。
A组1、3和5年总生存率分别为96.5%、84.9%和70.8%，B组分别为94.9%、75.8%和59.7%（P = 0.014）。A组相应的1、3和5年无复发生存率分别为78.2%、54.6%和52.3%，B组分别为62.6%、40.1%、24.5%（P < 0.001）。单因素和多因素分析结果表明，ΔALRI是RFS（P < 0.001，风险比[HR] 2.192，95%置信区间1.527 - 3.147）和OS（P < 0.001，HR 2.381，95%置信区间1.503 - 3.771）的独立预后因素。
肝切除术后ΔALRI为阳性预示小肝癌患者的OS和RFS降低。
