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血小板与淋巴细胞比值、中性粒细胞与淋巴细胞比值对肝细胞癌射频消融术后长期存活患者的预后评估价值
Value of platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in prognostic evaluation of patients with long-term survival after radiofrequency ablation for hepatocellular carcinoma
文章发布日期:2019年05月10日  来源:  作者:张洪海, 孙玉, 生守鹏, 等  点击次数:344次  下载次数:87次

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【摘要】:目的探讨血小板与淋巴细胞比值(PLR)、中性粒细胞与淋巴细胞比值(NLR)对射频消融术后生存期超过5年的肝细胞癌(HCC)患者预后评估价值。方法选取2006年6月-2012年2月于首都医科大学附属北京佑安医院行经肝动脉化疗栓塞术联合射频消融治疗且生存期超过5年的肝细胞癌患者135例。收集所有患者基线实验室及影像检查资料,根据血常规结果计算NLR与PLR。计数资料组间比较采用χ2检验。采用受试者工作特征曲线(ROC曲线)确定NLR、PLR临界值,Kaplan-Meier法绘制生存曲线,log-rank检验比较生存率,将log-rank检验分析中具有统计学差异的指标纳入Cox多因素分析。结果根据ROC曲线,确定NLR临界值为2.08,PLR临界值为96.82。按照治疗前NLR、PLR临界值分为:低NLR组(NLR<2.08,n=60)与高NLR组(NLR≥2.08,n=75),低PLR组(PLR<96.82,n=78)与高PLR组(PLR≥96.82,n=57),结果显示低NLR组与高NLR组患者AFP、巴塞罗那分期差异均有统计学意义(χ2值分别为15.125、9.649,P值均<0.05);低PLR组与高PLR组患者AFP、ChE、巴塞罗那分期、肿瘤大小差异均有统计学意义(χ2值分别为25.511、4.220、9.265、16.403,P<0.05)。低NLR组、低PLR组患者生存率分别高于高NLR组、高PLR组(χ2值分别为31.302、92.905,P值均<0.01)。Cox多因素分析显示,术前PLR[比值比(OR)=9634,95%可信区间(95%CI):5.167~17.964,P<0.001]、ChE(OR=0.404,95%CI:0.236~0.692,P=0.001)、肿瘤大小(OR=3.861,95%CI:1.760~8.472,P=0.001)、巴塞罗那分期(OR=9.607,95%CI:1.228~75.151,P=0.031)是HCC射频消融术后患者长期存活(生存期超过5年)生存率的独立影响因素。结论PLR是影响HCC射频消融术后长期存活患者生存率的独立危险因素,随着PLR升高,患者预后越差,可结合肿瘤相关情况作为评价HCC射频消融术后长期存活的重要预后指标。
【Abstract】:ObjectiveTo investigate the value of platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) in the prognostic evaluation of hepatocellular carcinoma (HCC) patients with a survival time of >5 years after radiofrequency ablation. MethodsA total of 135 HCC patients who underwent transcatheter arterial chemoembolization combined with radiofrequency ablation in Beijing YouAn Hospital, Capital Medical University, from June 2006 to February 2012 and had a survival time of >5 years were enrolled. Baseline laboratory and imaging data were collected, and NLR and PLR were calculated based on routine blood test results. The chi-square test was used for comparison of categorical data between groups. The receiver operating characteristic (ROC) curve was used to determine the cut-off values of NLR and PLR; the Kaplan-Meier method was used to plot survival curves, and the log-rank test was used to compare survival rates; the indices with statistical differences in the log-rank test were included in the Cox multivariate analysis. ResultsAccording to the ROC curve, the cut-off value of NLR was 2.08 and that of PLR was 96.82. According to the cut-off values of NLR and PLR before treatment, the patients were divided into low NLR group (NLR<2.08, 60 patients) and high NLR group (NLR≥2.08, 75 patients), as well as low PLR group (PLR<96.82, 78 patients) and high PLR group (PLR≥96.82, 57 patients). There were significant differences between the low NLR group and the high NLR group in alpha-fetoprotein (AFP) and BCLC stage (χ2=15.125 and 9.649, both P<0.05), and there were significant differences between the low PLR group and the high PLR group in AFP, cholinesterase (ChE), BCLC stage, and tumor size (χ2=25.511, 4.220, 9.265, and 16.403, P<0.05). The low NLR group had a significantly higher survival rate than the high NLR group (χ2=31.302, P<0.01), and the low PLR group had a significantly higher survival rate than the high PLR group (χ2=92905, P<0.01). The Cox multivariate analysis showed that preoperative PLR (odds ratio [OR]=9.634, 95% confidence interval [CI] 5.167-17.964, P<0.001), ChE (OR=0.404, 95% CI: 0.236-0.692, P=0.001), tumor diameter (OR=3.861, 95% CI: 1.760-8.472, P=0.001), and BCLC stage (OR=9.607, 95% CI: 1.228-75.151, P=0.031) were independent influencing factors for the survival rate of HCC patients with a long-term survival time (>5 years) after radiofrequency ablation. ConclusionPLR is an independent risk factor for survival rate of HCC patients with a long-term survival time after radiofrequency ablation, and the prognosis tend to become worse with the increase in PLR. With reference to tumor conditions, it can be used as an important prognostic indicator for the long-term survival of HCC patients after radiofrequency ablation.
【关键字】:癌, 肝细胞; 导管消融术; 血小板与淋巴细胞比值; 中性粒细胞与淋巴细胞比值; 预后; 危险因素
【Key words】:carcinoma, hepatocellular; catheter ablation; platelet to lymphocyte ratio; neutrophil to lymphocyte ratio; prognosis; risk factors
【引证本文】:ZHANG HH, SUN Y, SHENG SP, et al. Value of platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in prognostic evaluation of patients with long-term survival after radiofrequency ablation for hepatocellular carcinoma[J]. J Clin Hepatol, 2019, 35(5): 1014-1020. (in Chinese)
张洪海, 孙玉, 生守鹏, 等. 血小板与淋巴细胞比值、中性粒细胞与淋巴细胞比值对肝细胞癌射频消融术后长期存活患者的预后评估价值[J]. 临床肝胆病杂志, 2019, 35(5): 1014-1020.

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