Department of Infectious and Tropical Diseases, ASST Spedali Civili General Hospital, University of Brescia, Brescia, Italy.
Division of General Medicine, ASST Garda, Manerbio, Italy.
J Med Virol. 2019 Feb;91(2):241-248. doi: 10.1002/jmv.25317. Epub 2018 Oct 31.
To assess hepatocellular carcinoma (HCC) survival and to investigate the prognostic role of immunonutritional biomarkers, as neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and prognostic nutritional index (PNI), in a cohort of human immunodeficiency virus (HIV)-infected patients.
All HIV-positive patients diagnosed with HCC at our Department from January 2000 to December 2013 were included. The outcomes were overall survival (OS), recurrence-free survival (RFS), and liver-related death (LRD). To examine the role of inflammatory biomarkers on the outcomes, univariate and multivariable Cox regression models were used. Receiver operating characteristic (ROC) curves were implemented to evaluate the prediction role of NLR, PLR, and PNI.
A total of 40 patients (90% males) with a mean age of 48.3 years (SD = 5.6) were recruited. NLR ≥ 2.9 was associated with all causes mortality, as well as, PLR ≥ 126. NLR and PLR were predictors of OS, RFS, and LRD, while PNI did not emerge as a prognostic marker. According to the multivariate analysis, no HCC treatment was the only risk factor associated with risk of death. The areas under the ROC curves were 68.3 (95% confidence interval [CI], 54.5-82.1) for PLR and 66.3 (95% CI, 54.3-78.2) for NLR at 3 years; similar results were found at 5 years of follow-up.
Although, if examined singularly, NLR and PLR are prognostic factors for HCC recurrence and survival in HIV-infected patients, at the multivariate analysis, "no HCC treatment" remains the only independent risk factor associated with fatal outcome.
评估肝细胞癌（HCC）的生存率，并研究中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）和预后营养指数（PNI）等免疫营养生物标志物在人类免疫缺陷病毒（HIV）感染患者中的预后作用。
本研究纳入了 2000 年 1 月至 2013 年 12 月期间在我院确诊为 HCC 的所有 HIV 阳性患者。主要研究终点为总生存率（OS）、无复发生存率（RFS）和肝相关死亡率（LRD）。为了检验炎症生物标志物对结局的影响，采用单变量和多变量 Cox 回归模型。ROC 曲线用于评估 NLR、PLR 和 PNI 的预测作用。
共纳入 40 例（90%为男性）患者，平均年龄为 48.3 岁（标准差=5.6）。NLR≥2.9 与全因死亡率以及 PLR≥126 均相关。NLR 和 PLR 是 OS、RFS 和 LRD 的预测指标，而 PNI 则不是预后标志物。多变量分析显示，未进行 HCC 治疗是唯一与死亡风险相关的危险因素。PLR 的 ROC 曲线下面积为 68.3（95%可信区间[CI]，54.5-82.1），NLR 的 ROC 曲线下面积为 66.3（95%CI，54.3-78.2），这两种标志物在 3 年时均具有预测价值，在 5 年随访时也得到了相似的结果。
尽管 NLR 和 PLR 单独分析时是 HIV 感染患者 HCC 复发和生存的预后因素，但在多变量分析中，“未进行 HCC 治疗”仍然是与死亡结局相关的唯一独立危险因素。
