Zhang Deyao, Zeng Huilan, Pan Yangxun, Zhao Yumo, Wang Xin, Chen Jinbin, Wang Juncheng, Zhang Yaojun, Zhou Zhongguo, Xu Li, Chen Minshan, Hu Dandan
Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.
Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.
J Pers Med. 2022 Dec 9;12(12):2041. doi: 10.3390/jpm12122041.
To investigate the prognostic significance of liver tumor markers, the hemoglobin, albumin, lymphocyte, and platelet (HALP) score; neutrophil-to-lymphocyte ratio (NLR); and platelet-to-lymphocyte ratio (PLR), for predicting the specific site of recurrence or metastasis after surgery in patients with intrahepatic cholangiocarcinoma (ICC).
In total, 162 patients with pathologically proven ICC who underwent curative surgery at Sun Yat-sen University Cancer Center between April 2016 and April 2020 were analyzed. Clinicopathological characteristics were collected retrospectively. The Kaplan-Meier method was used to analyze the overall survival (OS) and recurrence-free survival (RFS). Significant clinical factors were examined by univariate analysis and multivariate analysis and analyzed by receiver operating characteristic (ROC) curve analysis.
The cutoff values for the HALP score, NLR, and PLR were determined to be 43.63, 3.73, and 76.51, respectively, using the surv_cutpoint function of survminer using RFS as the target variable. In multivariate analysis, vascular invasion, pathology nerve tract invasion, and carbohydrate antigen 19-9 (CA19-9) levels were independent prognostic factors of OS, whereas the tumor number, pathology microvascular invasion, pathology differentiation, CA19-9 levels, and NLR were independent prognostic factors of RFS. For the whole recurrence analysis, the carcinoembryonic antigen (CEA) index exhibited the largest ROC curve area of all (AUC = 0.590), and the alpha-fetoprotein (AFP) index exhibited the smallest ROC curve area (AUC = 0.530). The HALP score exhibited the largest ROC curve area of all in predicting intrahepatic recurrence (AUC = 0.588), the NLR showed the best predictive value in predicting lymph node metastasis (AUC = 0.703), and the AUC of the CA19-9 index was the largest of all variables in predicting distant metastasis (AUC = 0.619).
Our study showed that CA19-9, CEA, HALP score, and NLR are easily accessible, reliable, cost-effective indexes for predicting the specific site of recurrence or metastasis after surgery in ICC patients. Patients with high HALP scores and NLR have a higher risk of intrahepatic and lymph node metastasis recurrence.
为了研究肝脏肿瘤标志物、血红蛋白、白蛋白、淋巴细胞和血小板（HALP）评分、中性粒细胞与淋巴细胞比值（NLR）以及血小板与淋巴细胞比值（PLR）对肝内胆管癌（ICC）患者术后复发或转移具体部位的预测价值。
分析2016年4月至2020年4月期间在中山大学肿瘤防治中心接受根治性手术且病理确诊为ICC的162例患者。回顾性收集临床病理特征。采用Kaplan-Meier法分析总生存期（OS）和无复发生存期（RFS）。通过单因素分析和多因素分析检验显著临床因素，并采用受试者工作特征（ROC）曲线分析。
以RFS为目标变量，使用survminer的surv_cutpoint函数确定HALP评分、NLR和PLR的临界值分别为43.63、3.73和76.51。多因素分析显示，血管侵犯、病理神经束侵犯和糖类抗原19-9（CA19-9）水平是OS的独立预后因素，而肿瘤数量、病理微血管侵犯、病理分化程度、CA19-9水平和NLR是RFS的独立预后因素。在整个复发分析中，癌胚抗原（CEA）指数的ROC曲线面积最大（AUC = 0.590），甲胎蛋白（AFP）指数的ROC曲线面积最小（AUC = 0.530）。HALP评分在预测肝内复发方面的ROC曲线面积最大（AUC = 0.588），NLR在预测淋巴结转移方面具有最佳预测价值（AUC = 0.703），CA19-9指数在预测远处转移方面的AUC在所有变量中最大（AUC = 0.619）。
我们的研究表明，CA19-9、CEA、HALP评分和NLR是预测ICC患者术后复发或转移具体部位的易于获取、可靠且具有成本效益的指标。HALP评分高和NLR高的患者肝内和淋巴结转移复发风险更高。
