Zhang Zi-Fei, Wang Tao, Kong Jun-Jie, Yang Ling-Peng, Yang Xian-Wei, Wang Wen-Tao
Department of Liver Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610041, China.
Department of General Surgery, Affiliated Hospital of Xizang Minzu University, Xianyang 712000, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2020 May;51(3):403-410. doi: 10.12182/20200560207.
To evaluate the effect of perioperative inflammatory indicators on the prognosis of the patients with intrahepatic cholangiocarcinoma (ICC) after hepatectomy.
The clinical data of 231 ICC patients in the West China Hospital of Sichuan University from December 2006 to December 2016 were retrospectively collected. Neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (d-NLR) and platelet-to-lymphocyte ratio (PLR) of patients during the perioperative period (pre-operation, postoperative day 3 and day 5) were analyzed. The X-tile software was used to determine the optimal cut-off values of NLR, d-NLR and PLR in pre-operation, postoperative day 3 and day 5. Based on the cut-off values, all patients were divided into high level group and low level group, and Kaplan-Meier methods were used to analyze the correlations of NLR, d-NLR and PLR with the disease-free survival (DFS) and overall survival (OS) of patients. Univariate and multivariate Cox regression models were applied to assess the prognostic values of NLR, d-NLR and PLR. Nomogram was established to predict the prognosis for ICC patients, and the predicting accuracy was evaluated by the Consistency index ( -index).
A total of 231 ICC patients including 115 males and 116 females were enrolled into this study, and the proportion of patients aged <60 years was 57.1%. Among the patients enrolled, 161 patients (69.7%) recurred and 156 patients (67.5%) died after hepatectomy. The median time of DFS and OS were 8.9 and 12.5 months respectively. The Kaplan-Meier curves showed that d-NLR and NLR levels in pre-operation, postoperative day 3 and day 5, together with the preoperative PLR level were correlated with the time of DFS ( <0.05). Meanwhile, d-NLR and PLR levels in pre-operation, postoperative day 3 and day 5, together with the NLR level in pre-operation and postoperative day 3 were correlated with the time of OS ( <0.05). Univariate and multivariate Cox regression model analysis suggested that high level of the preoperative NLR and d-NLR, together with the high level of NLR on postoperative day 3 were the independent influencing factors of poor DFS. High level of the preoperative NLR and d-NLR, together with the high level of NLR on postoperative day 3 were the independent influencing factors of OS. The level of PLR level was not correlated with DFS and OS. The -index values of nomogram for predicting DFS and OS were 0.738 (95% confidence interval: 0.699-0.777) and 0.778 (95% confidence interval: 0.758-0.818), respectively.
High level of the preoperative NLR, preoperative d-NLR and NLR on postoperative day 3 in ICC patients indicate poor prognosis, and PLR has no prognostic value for ICC patients after hepatectomy.
评估围手术期炎症指标对肝切除术后肝内胆管癌（ICC）患者预后的影响。
回顾性收集2006年12月至2016年12月在四川大学华西医院就诊的231例ICC患者的临床资料。分析患者围手术期（术前、术后第3天和第5天）的中性粒细胞与淋巴细胞比值（NLR）、衍生中性粒细胞与淋巴细胞比值（d-NLR）和血小板与淋巴细胞比值（PLR）。采用X-tile软件确定术前、术后第3天和第5天NLR、d-NLR和PLR的最佳截断值。基于截断值，将所有患者分为高水平组和低水平组，采用Kaplan-Meier法分析NLR、d-NLR和PLR与患者无病生存期（DFS）和总生存期（OS）的相关性。应用单因素和多因素Cox回归模型评估NLR、d-NLR和PLR的预后价值。建立列线图预测ICC患者的预后，并通过一致性指数（C-index）评估预测准确性。
本研究共纳入231例ICC患者，其中男性115例，女性116例，年龄<60岁的患者占57.1%。纳入患者中，161例（69.7%）复发，156例（67.5%）肝切除术后死亡。DFS和OS的中位时间分别为8.9个月和12.5个月。Kaplan-Meier曲线显示，术前、术后第3天和第5天的d-NLR和NLR水平，以及术前PLR水平与DFS时间相关（P<0.05）。同时，术前、术后第3天和第5天的d-NLR和PLR水平，以及术前和术后第3天的NLR水平与OS时间相关（P<0.05）。单因素和多因素Cox回归模型分析表明，术前NLR和d-NLR高水平，以及术后第3天NLR高水平是DFS不良的独立影响因素。术前NLR和d-NLR高水平，以及术后第3天NLR高水平是OS的独立影响因素。PLR水平与DFS和OS无关。预测DFS和OS的列线图的C-index值分别为0.738（95%置信区间：0.699-0.777）和0.778（95%置信区间：0.758-0.818）。
ICC患者术前NLR、术前d-NLR和术后第3天NLR高水平提示预后不良，PLR对肝切除术后ICC患者无预后价值。
