Wang Yuchen, Attar Bashar M, Fuentes Harry E, Jaiswal Palashkumar, Tafur Alfonso J
Department of Internal Medicine, John H. Stroger Jr. Hospital, Chicago, IL, USA.
Department of Gastroenterology and Hepatology, John H. Stroger Jr. Hospital, Chicago, IL, USA.
J Gastrointest Oncol. 2017 Dec;8(6):1065-1071. doi: 10.21037/jgo.2017.09.06.
Hepatocellular carcinoma (HCC) is increasingly common, potentially fatal cancer type globally. Platelet-lymphocyte ratio (PLR) as a biomarker for systemic inflammation has recently been recognized as a valuable prognostic marker in multiple cancer types. The aim of the present study was to assess the prognostic value of PLR in HCC patients and determine the optimal cut-off value for risk stratification.
We retrospectively analyzed patients with diagnosis of HCC (screened by ICD-9 code, confirmed with radiographic examination and/or biopsy) at a large public hospital during 15 years (Jan 2000 through July 2015). PLR, among other serology laboratory values were collected at diagnosis of HCC. Its association with overall survival was evaluated with Cox proportional hazard model.
Among 270 patients with HCC, 57 (21.1%) patients died within an average follow-up of 11.9 months. PLR at diagnosis was significantly different between survivors and deceased (128.9 186.7; P=0.003). In multivariate analysis, aspartate transaminase (AST) (HR 2.022, P<0.001) and PLR (HR 1.768, P=0.004) independently predicted mortality. The optimal cut-off value for PLR was determined to be 220 by receiver-operating characteristics curve, and high PLR group had significantly higher mortality (HR 3.42, P<0.001).
Our results indicated that elevated PLR at diagnosis above 220 predicted poor prognosis in HCC patients. PLR is a low-cost and convenient tool, which may serve as a useful prognostic marker for HCC.
肝细胞癌（HCC）在全球范围内愈发常见，是一种具有潜在致命性的癌症类型。血小板淋巴细胞比率（PLR）作为全身炎症的生物标志物，最近已被公认为多种癌症类型中有价值的预后标志物。本研究的目的是评估PLR在肝癌患者中的预后价值，并确定风险分层的最佳临界值。
我们回顾性分析了一家大型公立医院15年间（2000年1月至2015年7月）诊断为HCC的患者（通过ICD - 9编码筛查，经影像学检查和/或活检确诊）。在HCC诊断时收集PLR以及其他血清学实验室值。采用Cox比例风险模型评估其与总生存期的关联。
在270例HCC患者中，57例（21.1%）在平均11.9个月的随访期内死亡。存活者和死亡者诊断时的PLR有显著差异（128.9对186.7；P = 0.003）。多因素分析中，天冬氨酸转氨酶（AST）（风险比2.022，P < 0.001）和PLR（风险比1.768，P = 0.004）独立预测死亡率。通过受试者工作特征曲线确定PLR的最佳临界值为220，高PLR组的死亡率显著更高（风险比3.42，P < 0.001）。
我们的结果表明，诊断时PLR高于220预示HCC患者预后不良。PLR是一种低成本且便捷的工具，可作为HCC有用的预后标志物。
