Qin Li, Li Chuan, Xie Fei, Wang Zhenxia, Wen Tianfu
Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Department of Hepato-pancreato-biliary Surgery, First People's Hospital of Neijiang, Neijiang, China.
Biosci Trends. 2020 Sep 21;14(4):297-303. doi: 10.5582/bst.2020.03180. Epub 2020 Jul 8.
Inflammation-based markers are considered prognostic indicators for patients with hepatocellular carcinoma (HCC) after liver resection. However, there is little information concerning whether they are useful for HCC patients with clinically significant portal hypertension (CSPH). In this study, 1452 patients were enrolled. Independent risk factors for recurrence-free survival (RFS) and overall survival (OS) were analyzed for patients with and without CSPH. For HCC patients without CSPH, multivariate analysis suggested that microvascular invasion (MVI), neutrophil-to-lymphocyte ratio (NLR) ≥ 3, platelet-to-lymphocyte ratio (PLR) ≥ 150, tumor size > 5 cm, and the presence of a satellite lesion were independently associated with RFS. MVI, NLR ≥ 3, PLR ≥ 150, and advanced Barcelona clinical liver cancer (BCLC) stage contributed to mortality. However, neither NLR nor PLR showed any prognostic power in HCC patients with CSPH. For HCC patients with CSPH, tumor size > 5 cm, MVI, satellite lesion, and albumin-bilirubin (ALBI) grade were independent risk factors for RFS, whereas tumor size > 5 cm, MVI, multiple tumors, ALBI grade and advanced BCLC stage showed prognostic power for OS. Our study confirmed CSPH influences the predictive ability of inflammation-based markers. This result reminds us to pay more attention to the influence of CSPH when we apply inflammation-based markers in patients with HCC after liver resection.
基于炎症的标志物被认为是肝细胞癌（HCC）肝切除术后患者的预后指标。然而，关于它们是否对具有临床显著门静脉高压（CSPH）的HCC患者有用的信息很少。在本研究中，纳入了1452例患者。分析了有和没有CSPH的患者无复发生存期（RFS）和总生存期（OS）的独立危险因素。对于没有CSPH的HCC患者，多因素分析表明，微血管侵犯（MVI）、中性粒细胞与淋巴细胞比值（NLR）≥3、血小板与淋巴细胞比值（PLR）≥150、肿瘤大小>5 cm以及存在卫星灶与RFS独立相关。MVI、NLR≥3、PLR≥150和巴塞罗那临床肝癌（BCLC）晚期与死亡率相关。然而，在有CSPH的HCC患者中，NLR和PLR均未显示出任何预后价值。对于有CSPH的HCC患者，肿瘤大小>5 cm、MVI、卫星灶和白蛋白-胆红素（ALBI）分级是RFS的独立危险因素，而肿瘤大小>5 cm、MVI、多发肿瘤、ALBI分级和BCLC晚期对OS具有预后价值。我们的研究证实CSPH会影响基于炎症的标志物的预测能力。这一结果提醒我们，在对肝切除术后的HCC患者应用基于炎症的标志物时，要更加关注CSPH的影响。
