Yang Cheng-Kun, Wei Zhong-Liu, Shen Xiao-Qiang, Jia Yu-Xuan, Wu Qiong-Yuan, Wei Yong-Guang, Su Hao, Qin Wei, Liao Xi-Wen, Zhu Guang-Zhi, Peng Tao
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
Guangxi Key Laboratory of Enhanced Recovery after Surgery for Gastrointestinal Cancer, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
World J Gastrointest Oncol. 2024 Dec 15;16(12):4579-4596. doi: 10.4251/wjgo.v16.i12.4579.
The prognostic impact of preoperative gamma-glutamyl transpeptidase to platelet ratio (GPR) levels in patients with solitary hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) following radical resection has not been established.
To examine the clinical utility of GPR for prognosis prediction in solitary HBV-related HCC patients.
A total of 1167 solitary HBV-related HCC patients were retrospectively analyzed. GPR levels were compared with 908 non-HCC individuals. Overall survival (OS) and recurrence-free survival (RFS) were evaluated, and cox proportional hazard model analyses were performed to identify independent risk factors. Differences in characteristics were adjusted by propensity score matching (PSM). Subgroup and stratified survival analyses for HCC risks were performed, and a linear trend of the hazard ratio (HR) according to GPR levels was constructed.
GPR levels of patients with solitary HBV-related HCC were higher than those with hepatic hemangiomas, chronic hepatitis B and healthy control (adjusted < 0.05). Variable bias was diminished after the PSM balance test. The low GPR group had improved OS ( < 0.001) and RFS ( < 0.001) in the PSM analysis and when combined with other variables. Multivariate cox analyses suggested that low GPR levels were associated with a better OS (HR = 0.5, 95%CI: 0.36-0.7, < 0.001) and RFS (HR = 0.57, 95%CI: 0.44-0.73, < 0.001). This same trend was confirmed in subgroup analyses. Prognostic nomograms were constructed and the calibration curves showed that GPR had good survival prediction. Moreover, stratified survival analyses found that GPR > 0.6 was associated with a worse OS and higher recurrence rate ( for trend < 0.001).
Preoperative GPR can serve as a noninvasive indicator to predict the prognosis of patients with solitary HBV-related HCC.
术前γ-谷氨酰转肽酶与血小板比值（GPR）水平对孤立性乙型肝炎病毒（HBV）相关肝细胞癌（HCC）患者根治性切除术后预后的影响尚未明确。
探讨GPR在孤立性HBV相关HCC患者预后预测中的临床应用价值。
回顾性分析1167例孤立性HBV相关HCC患者。将GPR水平与908例非HCC个体进行比较。评估总生存期（OS）和无复发生存期（RFS），并进行Cox比例风险模型分析以确定独立危险因素。通过倾向评分匹配（PSM）调整特征差异。对HCC风险进行亚组和分层生存分析，并根据GPR水平构建风险比（HR）的线性趋势。
孤立性HBV相关HCC患者的GPR水平高于肝血管瘤、慢性乙型肝炎患者及健康对照（校正后<0.05）。PSM平衡检验后可变偏倚减小。在PSM分析中以及与其他变量联合时，低GPR组的OS（<0.001）和RFS（<0.001）均有所改善。多因素Cox分析表明，低GPR水平与较好的OS（HR = 0.5，95%CI：0.36 - 0.7，<0.001）和RFS（HR = 0.57，95%CI：0.44 - 0.73，<0.001）相关。亚组分析证实了相同趋势。构建了预后列线图，校准曲线显示GPR具有良好的生存预测能力。此外，分层生存分析发现GPR>0.6与较差的OS和较高的复发率相关（趋势P<0.001）。
术前GPR可作为预测孤立性HBV相关HCC患者预后的无创指标。
