CAJ | 학술논문

目的：探讨术前肿瘤总体积（TTV）、外周血中性粒细胞与淋巴细胞比值（NLR）及乙型肝炎病毒（HBV-DNA）定量水平对预测HBV相关性肝细胞癌（HCC）术后肿瘤复发的价值。方法回顾性分析行根治性肝癌切除术的180例HCC临床资料，随访并记录患者肿瘤复发及存活情况，计算患者TTV和NLR，通过绘制TTV及NLR的受试者工作特征（Receiver operating characteristic, ROC）曲线确定预测肿瘤复发的相关界值。HBV-DNA界值定为1000 ng/mL。根据TTV、NLR及HBV-DNA界值分别将患者分为低TTV组和高TTV组、低NLR和高NLR组、低HBV-DNA及高HBA-DNA组，通过生存分析比较各组间无瘤生存率及累积生存率有无差异。结果当预测HCC患者术后肿瘤复发的TTV界值为183.59 cm3时，其灵敏度为0.492，特异度为0.964。NLR的界值为2.215时，其灵敏度为0.637，特异度为0.679。低TTV组、低NLR组与低HBV-DNA组患者的1、2、3年无瘤生存率和累积生存率均分别高于高TTV组、高NLR组与高HBV-DNA组，差异有统计学意义（P＜0.05）。TTV＞183.59 cm3、术前血清NLR＞2.215是影响患者术后肿瘤复发的独立危险因素。结论 TTV、术前NLR为影响HCC术后肿瘤复发的独立危险因素。TTV＞183.59 cm3、术前NLR＞2.215患者预后较差。
목적：탐토술전종류총체적（TTV）、외주혈중성립세포여림파세포비치（NLR）급을형간염병독（HBV-DNA）정량수평대예측HBV상관성간세포암（HCC）술후종류복발적개치。방법회고성분석행근치성간암절제술적180례HCC림상자료，수방병기록환자종류복발급존활정황，계산환자TTV화NLR，통과회제TTV급NLR적수시자공작특정（Receiver operating characteristic, ROC）곡선학정예측종류복발적상관계치。HBV-DNA계치정위1000 ng/mL。근거TTV、NLR급HBV-DNA계치분별장환자분위저TTV조화고TTV조、저NLR화고NLR조、저HBV-DNA급고HBA-DNA조，통과생존분석비교각조간무류생존솔급루적생존솔유무차이。결과당예측HCC환자술후종류복발적TTV계치위183.59 cm3시，기령민도위0.492，특이도위0.964。NLR적계치위2.215시，기령민도위0.637，특이도위0.679。저TTV조、저NLR조여저HBV-DNA조환자적1、2、3년무류생존솔화루적생존솔균분별고우고TTV조、고NLR조여고HBV-DNA조，차이유통계학의의（P＜0.05）。TTV＞183.59 cm3、술전혈청NLR＞2.215시영향환자술후종류복발적독립위험인소。결론 TTV、술전NLR위영향HCC술후종류복발적독립위험인소。TTV＞183.59 cm3、술전NLR＞2.215환자예후교차。
Objective To investigate the values of total tumor volume (TTV), preoperative peripheral blood neutrophil to lymphocyte ratio (NLR),and hepatitis B virus (HBV-DNA) level in predicting the tumor recurrence of patients with HBV-related hepatocellular carcinoma (HCC) after curative hepatectomy. Methods Clinical data of 180 patients with HBV-related HCC who underwent curative hepatectomy were retrospective-ly analyzed. All patients were followed up after hepatectomy, and their tumor recurrence and survival time were recorded. TTV and NLR were calculated according to the clinical data. Receiver operating characteristic (ROC) curves of TTV and NLR for predicting tumor recurrence were plotted, and the cut-off values were de-fined,respectively. The cut-off value of HBV-DNA for predicting tumor recurrence after hepatectomy was defined at 1,000 ng/mL in advance. The patients were divided into low TTV group and high TTV group, low NLR group and high NLR group, low HBV-DNA group and high HBV-DNA group respectively according to the cut-off values of TTV, NLR, and HBV-DNA. The differences of disease-free survival and cumulative survival rates between groups were compared with survival analysis. Clinical data were included as the factors influencing patients′disease-free survival rates by Cox proportional-hazards regression model. Survival anal-ysis was conducted using Kaplan-Meier method and Log-rank test. Survival prognosis was analyzed using Cox′s proportional-hazard model. Results When the cut-off value of TTV was defined at 183.59 cm3, the sensitivity was 0.492, and specificity was 0.964. When the cut-off value of NLR for predicting tumor recur-rence after operation was defined at 2.215, the sensitivity was 0.637, and specificity was 0.679. The 1,2,3-year disease-free survival and cumulative survival rates in low TTV group, low NLR group, and low HBV-DNA group were higher than those in high TTV group, high NLR group, and high HBV-DNA group respectively. The differences were statistically significant(P<0.05). Univariate and multivariate analysis with Cox propor-tional-hazards regression model showed that the independent risk factors for tumor recurrence were TTV>183.59 cm3, preoperative NLR>2.215. Conclusions TTV and preoperative NLR are independent risk factors for increasing the tumor recurrence in patients with HCC after curative hepatectomy. Patients with preoperative NLR>1.71 or TTV>183.59cm3 have poor prognosis.