Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Department of Laboratory Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
BMC Cancer. 2019 Jun 4;19(1):538. doi: 10.1186/s12885-019-5747-5.
Despite recent advances in the treatments of hepatocellular carcinoma (HCC), the prognosis of HCC patients remains controversial. The purpose of this study was to investigate the prognostic performance of pretreatment albumin to C-reactive protein ratio (ACR) in patients with HCC.
This study included 409 initially diagnosed HCC patients retrospectively. The optimal cut-off points for distinguishing high and low ACR value was determined by the X-tile software. The chi-squared test was used for comparing the baseline clinicopathologic parameters in different groups and subgroups. The Cox regression with log-rank tests was used to analyze OS and DFS, and Kaplan-Meier curves was used to estimate the prognosis of HCC patients.
Patients with lower ACR were significantly correlated with advanced clinical parameters, using a cut-off points of 5.4 (high ACR, n = 236 vs. low ACR, n = 173). Multivariate analysis demonstrated that ACR was associated with OS (HR = 0.544, 95% CI: 0.385-0.769, p = 0.001), with DFS (HR = 0.550, 95% CI: 0.392-0.772, p = 0.001). Treatment exposure (HR = 2.191; 95% CI: 1.533-3.132; p < 0.001), tumor size (HR = 1.973; 95% CI: 1.230-3.164; p = 0.005), serum AFP level (HR = 1.752; 95% CI: 1.277-2.403; p = 0.001), and TNM stage (HR = 0.470; 95% CI: 0.319-2.504; p < 0.001), were independent factors for OS in HCC patients. Treatment exposure (HR = 2.244; 95% CI: 1.590-3.166; p < 0.001), TNM stage (HR = 2.075; 95% CI: 1.436-3.000; p < 0.001), serum AFP level (HR = 1.819; 95% CI: 1.340-2.469; p = 0.001), tumor size (HR = 1.730; 95% CI: 1.113-2.689; p = 0.015), and ACR (HR = 0.550; 95% CI: 0.392-0.772; p = 0.001) were independent factors for DFS in HCC patients.
Pretreatment ACR is a convenient and useful parameter for HCC patients predicting OS and DFS. Lower ACR was associated with advanced TNM stage, larger tumor size, and a high concentration of AFP. These results may help to design strategies to personalize management approaches among HCC patients.
尽管肝细胞癌（HCC）的治疗方法最近有所进展，但 HCC 患者的预后仍存在争议。本研究旨在探讨治疗前白蛋白与 C 反应蛋白比值（ACR）在 HCC 患者中的预后价值。
本研究回顾性纳入了 409 例初诊 HCC 患者。使用 X-tile 软件确定区分高低 ACR 值的最佳截断点。采用卡方检验比较不同组和亚组的基线临床病理参数。采用 Cox 回归与 Log-rank 检验分析 OS 和 DFS，并使用 Kaplan-Meier 曲线估计 HCC 患者的预后。
使用 5.4 作为截断点（高 ACR，n=236 例；低 ACR，n=173 例），发现低 ACR 患者与晚期临床参数显著相关。多因素分析表明，ACR 与 OS 相关（HR=0.544，95%CI：0.385-0.769，p=0.001），与 DFS 相关（HR=0.550，95%CI：0.392-0.772，p=0.001）。治疗暴露（HR=2.191；95%CI：1.533-3.132；p<0.001）、肿瘤大小（HR=1.973；95%CI：1.230-3.164；p=0.005）、血清 AFP 水平（HR=1.752；95%CI：1.277-2.403；p=0.001）和 TNM 分期（HR=0.470；95%CI：0.319-2.504；p<0.001）是影响 HCC 患者 OS 的独立因素。治疗暴露（HR=2.244；95%CI：1.590-3.166；p<0.001）、TNM 分期（HR=2.075；95%CI：1.436-3.000；p<0.001）、血清 AFP 水平（HR=1.819；95%CI：1.340-2.469；p=0.001）、肿瘤大小（HR=1.730；95%CI：1.113-2.689；p=0.015）和 ACR（HR=0.550；95%CI：0.392-0.772；p=0.001）是影响 HCC 患者 DFS 的独立因素。
治疗前 ACR 是预测 HCC 患者 OS 和 DFS 的简便、有用的参数。较低的 ACR 与晚期 TNM 分期、较大的肿瘤大小和较高的 AFP 浓度相关。这些结果可能有助于制定策略，为 HCC 患者制定个体化的治疗方案。
