血红蛋白、白蛋白、淋巴细胞及血小板评分是接受根治性肝切除术治疗单发小肝细胞癌的Child-Pugh A级患者的一个预后因素。

The hemoglobin, albumin, lymphocyte, and platelet score is a prognostic factor for Child-Pugh A patients undergoing curative hepatic resection for single and small hepatocellular carcinoma.

作者信息

Toshida Katsuya, Itoh Shinji, Kayashima Hiroto, Nagao Yoshihiro, Yoshiya Shohei, Tomino Takahiro, Fujimoto Yukiko Kosai, Tsutsui Yuriko, Nakayama Yuki, Harada Noboru, Yoshizumi Tomoharu

机构信息

Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

出版信息

Hepatol Res. 2023 Jun;53(6):522-530. doi: 10.1111/hepr.13885. Epub 2023 Feb 10.

DOI:10.1111/hepr.13885

PMID:36719705

Abstract

AIM

The hemoglobin, albumin, lymphocyte, and platelet (HALP) score reflects the immune system and the nutritional status of patients, and prognosis in various cancers. However, the HALP score in hepatocellular carcinoma has not been reported.

METHODS

Data were analyzed retrospectively from Child-Pugh A patients undergoing hepatic resection for single hepatocellular carcinoma ≤5 cm. For cross-validation, patients were divided into the training (332 patients) and validation cohort (210 patients). In the training cohort, we divided patients into two groups by appropriate cut-off value of the HALP score, and univariable and multivariable analyses were conducted for disease-free and overall survival (OS) between two groups. In the validation cohort, we examined OS by Kaplan-Meier analysis in the same cut-off value of the HALP score in the training cohort.

RESULTS

The HALP-low group was significantly older (p = 0.0003), had fewer hepatitis B surface antigen-positive patients (p = 0.0369), higher prothrombin time (p = 0.0141), lower fibrosis-4 index (p = 0.0206), bigger maximum tumor size (p = 0.0196), and less histological liver fibrosis (p = 0.0077). Multivariate analysis showed that the independent prognostic factors for disease-free survival were fibrosis-4 index ≥2.67 (p = 0.0008), simple nodular type with extranodular growth or confluent multinodular type (p = 0.0221), and intrahepatic metastasis (p = 0.0233), and that for OS were fibrosis-4 index ≥2.67 (p = 0.0020), HALP ≤45.6 (p = 0.0228), and poor differentiation (p = 0.0305). In the validation cohort, Kaplan-Meier analysis revealed the trend toward significantly impaired OS (p = 0.0220) in the HALP-low group.

CONCLUSION

We showed that a low HALP score is the independent prognostic factor for Child-Pugh A patients undergoing curative hepatic resection for single and small hepatocellular carcinoma.

摘要

目的

血红蛋白、白蛋白、淋巴细胞及血小板（HALP）评分反映患者的免疫系统和营养状况以及各种癌症的预后。然而，肝细胞癌中的HALP评分尚未见报道。

方法

对因单发直径≤5 cm肝细胞癌接受肝切除的Child-Pugh A级患者的数据进行回顾性分析。为进行交叉验证，将患者分为训练队列（332例患者）和验证队列（210例患者）。在训练队列中，我们根据HALP评分的合适临界值将患者分为两组，并对两组之间的无病生存期和总生存期（OS）进行单变量和多变量分析。在验证队列中，我们在训练队列中HALP评分的相同临界值下通过Kaplan-Meier分析检查OS。

结果

HALP低分组患者年龄显著更大（p = 0.0003），乙肝表面抗原阳性患者更少（p = 0.0369），凝血酶原时间更高（p = 0.0141），纤维化-4指数更低（p = 0.0206），最大肿瘤尺寸更大（p = 0.0196），组织学肝纤维化程度更低（p = 0.0077）。多变量分析显示，无病生存期的独立预后因素为纤维化-4指数≥2.67（p = 0.0008）、具有结节外生长的单纯结节型或融合多结节型（p = 0.0221）以及肝内转移（p = 0.0233），总生存期的独立预后因素为纤维化-4指数≥2.67（p = 0.0020）、HALP≤45.6（p = 0.0228）以及低分化（p = 0.0305）。在验证队列中，Kaplan-Meier分析显示HALP低分组患者的总生存期有显著受损的趋势（p = 0.0220）。