AGLR 是一种用于预测肝细胞癌患者预后的新型指标：一项回顾性研究。

AGLR is a novel index for the prognosis of hepatocellular carcinoma patients: a retrospective study.

机构信息

Laboratory of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, 541001, Guangxi, People's Republic of China.

Disease Prevention and Control Center of Guilin, Guilin, Guangxi, People's Republic of China.

出版信息

BMC Surg. 2021 Feb 3;21(1):72. doi: 10.1186/s12893-020-01037-7.

DOI:10.1186/s12893-020-01037-7

PMID:33536005

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7860009/

Abstract

BACKGROUND

Most hepatocellular carcinoma (HCC) patients' liver function indexes are abnormal. We aimed to investigate the relationship between (alkaline phosphatase + gamma-glutamyl transpeptidase)/lymphocyte ratio (AGLR) and the progression as well as the prognosis of HCC.

METHODS

A total of 495 HCC patients undergoing radical hepatectomy were retrospectively analyzed. We randomly divided these patients into the training cohort (n = 248) and the validation cohort (n = 247). In the training cohort, receiver operating characteristic (ROC) curve was used to determine the optimal cut-off value of AGLR for predicting postoperative survival of HCC patients, and the predictive value of AGLR was evaluated by concordance index (C-index). Further analysis of clinical and biochemical data of patients and the correlation analysis between AGLR and other clinicopathological factors were finished. Univariate and multivariate analyses were performed to identify prognostic factors for HCC patients. Survival curves were analyzed using the Kaplan-Meier method.

RESULTS

According to the ROC curve analysis, the optimal predictive cut-off value of AGLR was 90. The C-index of AGLR was 0.637 in the training cohort and 0.654 in the validation cohort, respectively. Based on this value, the HCC patients were divided into the low-AGLR group (AGLR ≤ 90) and the high-AGLR group (AGLR > 90). Preoperative AGLR level was positively correlated with alpha-fetoprotein (AFP), tumor size, tumor-node-metastasis (TNM) stage, and microvascular invasion (MVI) (all p < 0.05). In the training and validation cohorts, patients with AGLR > 90 had significantly shorter OS than patients with AGLR ≤ 90 (p < 0.001). Univariate and multivariate analyses of the training cohort (HR, 1.79; 95% CI 1.21-2.69; p < 0.001) and validation cohort (HR, 1.82; 95% CI 1.35-2.57; p < 0.001) had identified AGLR as an independent prognostic factor. A new prognostic scoring model was established based on the independent predictors determined in multivariate analysis.

CONCLUSIONS

The elevated preoperative AGLR level indicated poor prognosis for patients with HCC; the novel prognostic scoring model had favorable predictive capability for postoperative prognosis of HCC patients, which may bring convenience for clinical management.

摘要

背景

大多数肝细胞癌 (HCC) 患者的肝功能指标异常。我们旨在探讨 (碱性磷酸酶+γ-谷氨酰转肽酶)/淋巴细胞比值 (AGLR) 与 HCC 进展和预后的关系。

方法

回顾性分析了 495 例接受根治性肝切除术的 HCC 患者。我们将这些患者随机分为训练队列 (n=248) 和验证队列 (n=247)。在训练队列中，使用受试者工作特征 (ROC) 曲线确定 AGLR 预测 HCC 患者术后生存的最佳截断值，并通过一致性指数 (C-index) 评估 AGLR 的预测价值。进一步分析患者的临床和生化数据，并进行 AGLR 与其他临床病理因素的相关性分析。进行单因素和多因素分析，以确定 HCC 患者的预后因素。使用 Kaplan-Meier 方法分析生存曲线。

结果

根据 ROC 曲线分析，AGLR 的最佳预测截断值为 90。AGLR 在训练队列和验证队列中的 C-index 分别为 0.637 和 0.654。基于该值，将 HCC 患者分为低 AGLR 组 (AGLR≤90) 和高 AGLR 组 (AGLR>90)。术前 AGLR 水平与甲胎蛋白 (AFP)、肿瘤大小、肿瘤-淋巴结-转移 (TNM) 分期和微血管侵犯 (MVI) 呈正相关 (均 p<0.05)。在训练队列和验证队列中，AGLR>90 的患者的 OS 明显短于 AGLR≤90 的患者 (p<0.001)。训练队列的单因素和多因素分析 (HR，1.79；95%CI，1.21-2.69；p<0.001) 和验证队列 (HR，1.82；95%CI，1.35-2.57；p<0.001) 均确定 AGLR 为独立预后因素。基于多因素分析确定的独立预测因子建立了新的预后评分模型。