CAJ | 학술논문

目的评价乙型肝炎(HBV)相关肝细胞肝癌(HCC)患者,经肝动脉灌注化疗栓塞(TACE)术前中性粒细胞/淋巴细胞比值(NLR)对TACE治疗后预后的影响.方法回顾性分析546例HBV相关HCC患者临床和实验室检查资料,单因素分析TACE前肿瘤最大径、肿瘤数目、甲胎蛋白(AFP)水平、血管侵犯、TACE前后NLR、TACE次数与患者生存之间的关系,将上述有统计学意义的影响因素逐一引入Cox回归模型进行多因素分析.结果本组患者1、3、5年生存率分别为56.2%、18.9%、7.6%.NLR<3.0和NLR≥3.0患者1、3、5年生存率分别为62.0%、25.0%、12.5%和56.2%、17.0%、6.9%,通过Log-Rank法检验比较,两组差异有统计学意义(χ2=7.751,P<0.01).单因素分析显示肿瘤最大径≥5 cm、肿瘤数目≥3个、AFP≥400μg/L、血管侵及、TACE前后NLR均≥3.0影响患者长期生存率(P值均<0.05).通过Cox回归分析结果显示肿瘤数目≥3个、血管受侵、TACE治疗前NLR≥3.0是影响患者生存时间的独立危险因素.结论除TACE治疗前肿瘤数目、血管受侵外,NLR≥3.0是影响HBV相关HCC患者预后的危险因素.
목적 평개을형간염(HBV)상관간세포간암(HCC)환자,경간동맥관주화료전새(TACE)술전중성립세포/림파세포비치(NLR)대TACE치료후예후적영향.방법 회고성분석546례HBV상관HCC환자림상화실험실검사자료,단인소분석TACE전종류최대경、종류수목、갑태단백(AFP)수평、혈관침범、TACE전후NLR、TACE차수여환자생존지간적관계,장상술유통계학의의적영향인소축일인입Cox회귀모형진행다인소분석.결과 본조환자1、3、5년생존솔분별위56.2%、18.9%、7.6%.NLR<3.0화NLR≥3.0환자1、3、5년생존솔분별위62.0%、25.0%、12.5%화56.2%、17.0%、6.9%,통과Log-Rank법검험비교,량조차이유통계학의의(χ2=7.751,P<0.01).단인소분석현시종류최대경≥5 cm、종류수목≥3개、AFP≥400μg/L、혈관침급、TACE전후NLR균≥3.0영향환자장기생존솔(P치균<0.05).통과Cox회귀분석결과현시종류수목≥3개、혈관수침、TACE치료전NLR≥3.0시영향환자생존시간적독립위험인소.결론 제TACE치료전종류수목、혈관수침외,NLR≥3.0시영향HBV상관HCC환자예후적위험인소.
Objective To evaluate the negative impact of preoperative neutrophil-lymphocyte ratio (NLR) on preding survival in patients with HBV (hepatitis B virus)-associated hepatocellular carcinoma (HCC) before transarterial chemoembolization(TACE) treatment. Methods The clinical data of HBV-associated HCC patients undergoing TACE were retrospectively analyzed. Their clinical risk factors for survival were evaluated by univariate analysis. Cox multiple regression was performed to determine the parameters forpredicting the HCC survival, NLR≥3.0 was considered to be elevated. Results A total of 546 cases were identified. Among them, 234 patients had an elevated NLR. The 1-, 3-and 5-year survival rates were 56.2%, 18.9%and 7.6%respectively. The survival rates for patients with normal NLR was significantly better than that ofthose with high NLR(1-,3-,and 5-year survivals at 62.0%, 25.0%and 12.5%vs 56.2%, 17.0%and 6.9%respectively;P=0.005). Univariate analysis of factors revealed that large tumor (≥5 cm), tumor number≥3, vascular invasion, serum-fetoprotein level≥400μg/L and NLR≥3.0 were preoperative predictors of survival. Cox regression analysis showed that the presence of tumor number≥3, vascular invasion and NLR≥3.0 were independent prognostic factors of worse survival. Conclusion Preoperative NLR≥3.0 was a negative prognostic factor of overall survival for HBV-associated HCC patients after TACE treatment.