天门冬氨酸氨基转移酶与淋巴细胞比值指数对肝癌术后早期的预后价值：倾向评分匹配分析。

The prognostic value of aspartate aminotransferase-to-lymphocyte ratio index in early-stage hepatocellular carcinoma after hepatectomy: A propensity-score matched analysis.

机构信息

Department of Hepatobiliary Surgery, Fuling Central Hospital, Chongqing, 408000, China.

Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China.

出版信息

Asia Pac J Clin Oncol. 2021 Oct;17(5):e238-e248. doi: 10.1111/ajco.13458. Epub 2020 Oct 30.

DOI:10.1111/ajco.13458

PMID:33124200

Abstract

BACKGROUND

An elevated preoperative aspartate aminotransferase-to-lymphocyte ratio index (ALRI) may predict poor survival in various cancers. However, the prognostic value of aminotransferase-to-lymphocyte ratio index (ALRI) in patients with hepatocellular carcinoma (HCC) remains to be determined.

MATERIALS AND METHODS

A retrospective cohort study was conducted among 983 patients with HCC in our hospital from February 2007 to March 2016. A propensity-score matching (PSM) was performed to correct the selection bias and confounding factors. The risk of death and recurrence was plotted over aminotransferase-to-lymphocyte ratio index (ALRI) using the locally weighted scatterplot smoothing (LOWESS)-smoothed fit curve. Time-dependent receiver operating characteristic (ROC) and Kaplan-Meier method analysis was utilized to the role of aminotransferase-to-lymphocyte ratio index (ALRI) in HCC. Multivariate analysis was conducted to identify independent prognostic factors associated with overall survival (OS) and recurrence-free survival (RFS).

RESULTS

With the increase of aminotransferase-to-lymphocyte ratio index (ALRI), the risk of recurrence and death in HCC patients increases. In time-dependent ROC analysis, the AUC of aminotransferase-to-lymphocyte ratio index (ALRI) for predicting 1-, 3- and 5-year OS were 0.668 (95% CI: 0.596-0.740), 0.605 (95% CI: 0.560-0.649) and 0.613 (95% CI: 0.570-0.656), respective. The AUC of aminotransferase-to-lymphocyte ratio index (ALRI) for predicting 1-, 3- and 5-year RFS were 0.598 (95% CI: 0.555-0.641), 0.590 (95% CI: 0.552-0.628) and 0.604 (95% CI: 0.562-0.646), respectively. HCC patients with high aminotransferase-to-lymphocyte ratio index (ALRI) had a poor overall survival. Moreover, cox regression analysis revealed that aminotransferase-to-lymphocyte ratio index (ALRI) was an independent factor affecting the prognosis of HCC patients.

CONCLUSIONS

Elevated preoperative aminotransferase-to-lymphocyte ratio index (ALRI) is a noninvasive, simple, and effective predictor in the prognosis of patients with HCC.

摘要

背景

天门冬氨酸转氨酶与淋巴细胞比值指数（ALRI）升高可能预示着多种癌症的生存不良。然而，天门冬氨酸转氨酶与淋巴细胞比值指数（ALRI）在肝细胞癌（HCC）患者中的预后价值仍有待确定。

材料和方法

对 2007 年 2 月至 2016 年 3 月我院 983 例 HCC 患者进行回顾性队列研究。采用倾向评分匹配（PSM）校正选择偏倚和混杂因素。使用局部加权散点平滑（LOWESS）拟合曲线对天门冬氨酸转氨酶与淋巴细胞比值指数（ALRI）进行死亡和复发风险绘图。采用时间依赖性接收器工作特征（ROC）和 Kaplan-Meier 方法分析天门冬氨酸转氨酶与淋巴细胞比值指数（ALRI）在 HCC 中的作用。采用多变量分析确定与总生存期（OS）和无复发生存期（RFS）相关的独立预后因素。

结果

随着天门冬氨酸转氨酶与淋巴细胞比值指数（ALRI）的升高，HCC 患者的复发和死亡风险增加。在时间依赖性 ROC 分析中，天门冬氨酸转氨酶与淋巴细胞比值指数（ALRI）预测 1、3 和 5 年 OS 的 AUC 分别为 0.668（95%CI：0.596-0.740）、0.605（95%CI：0.560-0.649）和 0.613（95%CI：0.570-0.656）。天门冬氨酸转氨酶与淋巴细胞比值指数（ALRI）预测 1、3 和 5 年 RFS 的 AUC 分别为 0.598（95%CI：0.555-0.641）、0.590（95%CI：0.552-0.628）和 0.604（95%CI：0.562-0.646）。HCC 患者的天门冬氨酸转氨酶与淋巴细胞比值指数（ALRI）较高，其总体生存较差。此外，cox 回归分析表明，天门冬氨酸转氨酶与淋巴细胞比值指数（ALRI）是影响 HCC 患者预后的独立因素。