Li Siming, Xu Wentao, Liao Minjun, Zhou Yuanping, Weng Jun, Ren Liying, Yu Junxiong, Liao Weijia, Huang Zhaoquan
Laboratory of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, 541001, Guangxi, People's Republic of China.
Department of Infectious Diseases, Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, People's Republic of China.
J Hepatocell Carcinoma. 2021 Feb 9;8:23-33. doi: 10.2147/JHC.S286213. eCollection 2021.
Currently, there is still a lack of effective biomarkers for the recurrence monitoring and survival prognosis assessment of hepatocellular carcinoma (HCC) patients with alpha-fetoprotein (AFP)-negative (≤20 ng/mL) after radical resection.
The clinicopathological data of 606 patients (303 in the AFP-negative group and 303 in the AFP-positive group) who underwent radical resection of HCC were analyzed retrospectively.
The gamma-glutamyl transpeptidase to lymphocyte count ratio (GLR) of patients in the AFP-negative group was lower than that in the AFP-positive group ( <0.001). The GLR level of the early-recurrence group was higher than that of the non-early-recurrence group ( =0.003). GLR had fair accuracy in predicting the early-recurrence of HCC patients [c-index=0.654 (95% CI=0.606-0.702); AUC=0.681 (95% CI=0.625-0.733)]. Univariate analysis showed that patients with tumor size <5 cm, no microvascular invasion, single tumor, no metastasis, BCLC stage 0-A, no recurrence, and GLR ≤45.0 had longer disease-free survival (DFS) and overall survival (OS) among AFP-negative HCC patients. In addition, multivariate Cox proportional hazards regression analysis showed that tumor size <5 cm ( =0.003), no recurrence ( <0.001), and GLR <45.0 ( <0.001) were independent predictors of longer OS.
GLR may be a potential indicator for early recurrence monitoring and prognosis evaluation in HCC patients with AFP-negative after radical resection.
目前，对于根治性切除术后甲胎蛋白（AFP）阴性（≤20 ng/mL）的肝细胞癌（HCC）患者，仍缺乏有效的生物标志物用于复发监测和生存预后评估。
回顾性分析606例行HCC根治性切除术患者（AFP阴性组303例，AFP阳性组303例）的临床病理资料。
AFP阴性组患者的γ-谷氨酰转肽酶与淋巴细胞计数比值（GLR）低于AFP阳性组（<0.001）。早期复发组的GLR水平高于非早期复发组（=0.003）。GLR在预测HCC患者早期复发方面具有较好的准确性[c指数=0.654（95%CI=0.606-0.702）；AUC=0.681（95%CI=0.625-0.733）]。单因素分析显示，在AFP阴性的HCC患者中，肿瘤大小<5 cm、无微血管侵犯、单发病灶、无转移、BCLC分期0-A、无复发且GLR≤45.0的患者无病生存期（DFS）和总生存期（OS）更长。此外，多因素Cox比例风险回归分析显示，肿瘤大小<5 cm（=0.003）、无复发（<0.001）和GLR<45.0（<0.001）是OS更长的独立预测因素。
GLR可能是根治性切除术后AFP阴性的HCC患者早期复发监测和预后评估的潜在指标。
