中性粒细胞与淋巴细胞比值和白蛋白-胆红素分级在肝细胞癌中的应用：一项系统综述。
Neutrophil to lymphocyte ratio and albumin bilirubin grade in hepatocellular carcinoma: A systematic review.
机构信息
Department of Gastroenterology and Hepatology, University Hospital Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, West Midlands, United Kingdom.
出版信息
World J Gastroenterol. 2020 Sep 7;26(33):5022-5049. doi: 10.3748/wjg.v26.i33.5022.
BACKGROUND
Hepatocellular carcinoma (HCC) is a frequent cause of cancer related death globally. Neutrophil to lymphocyte ratio (NLR) and albumin bilirubin (ALBI) grade are emerging prognostic indicators in HCC.
AIM
To study published literature of NLR and ALBI over the last five years, and to validate NLR and ALBI locally in our centre as indicators of HCC survival.
METHODS
A systematic review of the published literature on PubMed of NLR and ALBI in HCC over the last five years. The search followed the guidelines of the preferred reporting items for systematic reviews and meta-analyses. Additionally, we also investigated HCC cases between December 2013 and December 2018 in our centre.
RESULTS
There were 54 studies describing the relation between HCC and NLR and 95 studies describing the relation between HCC and ALBI grade over the last five years. Our local cohort of patients showed NLR to have a significant negative relationship to survival ( = 0.011). There was also significant inverse relationship between the size of the largest HCC nodule and survival ( = 0.009). Median survival with alpha fetoprotein (AFP) < 10 KU/L was 20 mo and with AFP > 10 KU/L was 5 mo. We found that AFP was inversely related to survival, this relationship was not statically significant ( = 0.132). Mean survival for ALBI grade 1 was 37.7 mo, ALBI grade 2 was 13.4 months and ALBI grade 3 was 4.5 mo. ALBI grades performed better than Child Turcotte Pugh score in detecting death from HCC.
CONCLUSION
NLR and ALBI grade in HCC predict survival better than the conventional alpha fetoprotein. ALBI grade performs better than Child Turcotte Pugh score. These markers are done as part of routine clinical care and in cases of normal alpha fetoprotein, these markers could give a better understanding of the patient disease progression. NLR and ALBI grade could have a role in modified easier to learn staging and prognostic systems for HCC.
背景
肝细胞癌（HCC）是全球癌症相关死亡的常见原因。中性粒细胞与淋巴细胞比值（NLR）和白蛋白胆红素（ALBI）分级是 HCC 的新兴预后指标。
目的
研究过去五年发表的 NLR 和 ALBI 文献，并在我们中心验证 NLR 和 ALBI 作为 HCC 生存的指标。
方法
对过去五年在 PubMed 上发表的关于 NLR 和 ALBI 在 HCC 中的文献进行系统评价。该搜索遵循系统评价和荟萃分析的首选报告项目指南。此外，我们还调查了我们中心 2013 年 12 月至 2018 年 12 月期间的 HCC 病例。
结果
在过去五年中，有 54 项研究描述了 HCC 与 NLR 之间的关系，有 95 项研究描述了 HCC 与 ALBI 分级之间的关系。我们的本地患者队列显示 NLR 与生存呈显著负相关（ = 0.011）。最大 HCC 结节的大小与生存之间也存在显著的反比关系（ = 0.009）。甲胎蛋白（AFP）<10KU/L 时的中位生存时间为 20 个月，AFP>10KU/L 时的中位生存时间为 5 个月。我们发现 AFP 与生存呈负相关，但这种关系没有统计学意义（ = 0.132）。ALBI 分级 1 的平均生存时间为 37.7 个月，ALBI 分级 2 为 13.4 个月，ALBI 分级 3 为 4.5 个月。ALBI 分级在检测 HCC 死亡方面优于 Child-Turcotte-Pugh 评分。
结论
NLR 和 ALBI 分级在 HCC 中比传统的 AFP 更能预测生存。ALBI 分级比 Child-Turcotte-Pugh 评分表现更好。这些标志物是作为常规临床护理的一部分进行的，在 AFP 正常的情况下，这些标志物可以更好地了解患者的疾病进展。NLR 和 ALBI 分级在 HCC 更易于学习的分期和预后系统中可能发挥作用。
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