Feng Guo-Ying, Shi Zheng-Rong, Zhao Yu-Fei, Chen Kai, Tao Jie, Wei Xu-Fu, Cheng Yu
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, Chongqing, China.
Front Surg. 2023 Jan 6;9:1072451. doi: 10.3389/fsurg.2022.1072451. eCollection 2022.
To evaluate the feasibility of the preoperative neutrophil-to-lymphocyte ratio (NLR) as an index to guide postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) in patients with liver cancer.
We recruited a total of 166 patients with liver cancer who underwent surgery alone or surgery plus PA-TACE between January 2013 and June 2017 and compared the 1, 2, and 3-year recurrence-free survival (RFS) and overall survival (OS) between patients with high and low NLRs, surgery and surgery plus PA-TACE groups, and relevant subgroups using the Kaplan-Meier method. We also evaluated the independent factors affecting the prognosis of liver cancer after surgery using a Cox risk ratio model and correlation between NLR levels and high-risk recurrence factors of liver cancer with logistic regression analysis.
The 1, 2, and 3-year RFS rates were all significantly higher in the low-NLR group compared to the high-NLR group ( < 0.05). However, the 1, 2, and 3-year OS rates were similar in the low- and high-NLR groups ( > 0.05). After propensity score matching, the 1, 2, and 3-year RFS and OS rates were significantly better in patients treated with surgery plus PA-TACE compared with surgery alone ( < 0.05). The 1, 2, and 3-year RFS and OS rates were also significantly better in the surgery plus PA-TACE subgroup compared with the surgery-alone subgroup in the high-NLR group ( < 0.05), but there was no significant difference in RFS or OS between the surgery plus PA-TACE and surgery-alone subgroups at 1, 2, and 3 years in the low-NLR group ( > 0.05). Multivariate analysis in the high-NLR group showed that a poorly differentiated or undifferentiated tumor was an independent risk factor for postoperative RFS. Multiple tumors were an independent risk factor for postoperative OS ( < 0.05), while PA-TACE was an independent protective factor for postoperative RFS and OS ( < 0.05). In the low-NLR group, AFP > 400 µg/L was an independent risk factor for postoperative OS ( < 0.05). Multivariate logistic regression indicated that patients with a maximum tumor diameter of >5 cm were at increased risk of having high NLR levels compared to patients with a maximum tumor diameter of <5 cm ( < 0.05).
PA-TACE can improve the prognosis of patients with a high preoperative NLR (≥2.5), but has no obvious benefit in patients with low preoperative NLR (<2.5). This may provide a reference for clinical selection of PA-TACE.
评估术前中性粒细胞与淋巴细胞比值（NLR）作为指导肝癌患者术后辅助性经动脉化疗栓塞术（PA-TACE）指标的可行性。
我们共招募了166例在2013年1月至2017年6月期间接受单纯手术或手术加PA-TACE的肝癌患者，采用Kaplan-Meier法比较高NLR组与低NLR组、手术组与手术加PA-TACE组以及相关亚组之间的1年、2年和3年无复发生存率（RFS）和总生存率（OS）。我们还使用Cox风险比模型评估影响肝癌术后预后的独立因素，并通过逻辑回归分析评估NLR水平与肝癌高危复发因素之间的相关性。
低NLR组的1年、2年和3年RFS率均显著高于高NLR组（P<0.05）。然而，低NLR组和高NLR组的1年、2年和3年OS率相似（P>0.05）。倾向评分匹配后，手术加PA-TACE治疗的患者的1年、2年和3年RFS和OS率显著优于单纯手术治疗的患者（P<0.05）。在高NLR组中，手术加PA-TACE亚组的1年至3年RFS和OS率也显著优于单纯手术亚组（P<0.05），但在低NLR组中，手术加PA-TACE亚组与单纯手术亚组在1年、2年和3年的RFS或OS方面无显著差异（P>0.05）。高NLR组的多因素分析显示，低分化或未分化肿瘤是术后RFS的独立危险因素。多个肿瘤是术后OS的独立危险因素（P<0.05），而PA-TACE是术后RFS和OS的独立保护因素（P<0.05）。在低NLR组中，甲胎蛋白>400μg/L是术后OS的独立危险因素（P<0.05）。多因素逻辑回归表明，最大肿瘤直径>5cm的患者与最大肿瘤直径<5cm的患者相比，NLR水平升高的风险增加（P<0.05）。
PA-TACE可改善术前NLR高（≥2.5）患者的预后，但对术前NLR低（<2.5）的患者无明显益处。这可能为临床选择PA-TACE提供参考。
