中性粒細胞與淋巴細胞和血小板比值聯合評分對于肝細胞癌切除術后的預后預測價值_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

周宇 ¹ , 劉卓然 ¹ , 梅名強 ¹ ,  付文廣 ^1,2

1. ;
2. ;

Corresponding?author：

付文廣, Email: fuwg@swmu.edu.cn

Keywords：

肝細胞癌; 中性粒細胞; 淋巴細胞; 血小板; 預后

DOI：

10.7507/1007-9424.202304060

Video：

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目的探討中性粒細胞與淋巴細胞比值（neutrophil to lymphocyte ratio，NLR）聯合中性粒細胞與血小板比值（neutrophil to platelet ratio，NPR）評分對于肝細胞癌切除術后的預后預測價值。方法本研究回顧性收集了2013年7月至2021年12月期間于西南醫科大學附屬醫院肝膽胰外科住院并接受手術切除且符合本研究納入標準的肝細胞癌患者的臨床病理資料，同時采用單因素和多因素Cox比例風險回歸分析影響肝細胞癌手術后總生存的危險因素并建立列線圖預測模型。結果本研究共納入了符合標準的肝細胞癌患者283例。NLR、NPR 及NLR聯合NPR 評分判斷肝細胞癌術后總生存率的受試者操作特征曲線下面積（95%可信區間）分別為 0.643（0.579，0.708）、0.646（0.582，0.710）及0.703（0.642，0.763）。多因素分析結果顯示，乙肝病毒感染（P=0.047）、丙氨酸轉氨酶＞40 U/L（P=0.012）、甲胎蛋白＞400 μg/L（P=0.001）、腫瘤最大直徑＞5 cm（P=0.011）、腫瘤數目多個（P=0.010）、NLR 聯合 NPR 評分 1/2 分（P=0.001/P＜0.001）為肝細胞癌術后患者總生存的危險因素，基于這 6 個因素建立的列線圖預測模型預測 5 年總生存率的受試者操作特征曲線下面積（95%可信區間）為 0.749（0.675，0.823）。結論本研究結果提示，患者術前NLR聯合NPR評分有作為評估肝細胞癌切除術后患者的預后預測指標的潛在價值。

Citation： 周宇, 劉卓然, 梅名強, 付文廣. 中性粒細胞與淋巴細胞和血小板比值聯合評分對于肝細胞癌切除術后的預后預測價值. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(8): 970-973. doi: 10.7507/1007-9424.202304060 Copy

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2.	四川大學華西醫院肝癌MDT團隊. 肝細胞肝癌全程多學科規范化管理: 華西醫院多學科專家共識(第二版). 中國普外基礎與臨床雜志, 2020, 27(9): 1062-1077.
3.	閻龍, 戴朝六. 上皮-間質轉化與肝細胞癌炎癥微環境的關系研究. 中國普外基礎與臨床雜志, 2017, 24(7): 885-889.
4.	Li Y, Wang WB, Yang L, et al. The combination of body composition conditions and systemic inflammatory markers has prognostic value for patients with gastric cancer treated with adjuvant chemoradiotherapy. Nutrition, 2022, 93: 111464. doi: 10.1016/j.nut.2021.111464.
5.	Yang HJ, Guo Z, Yang YT, et al. Blood neutrophil-lymphocyte ratio predicts survival after hepatectomy for hepatocellular carcinoma: a propensity score-based analysis. World J Gastroenterol, 2016, 22(21): 5088-5095.
6.	斯瑩, 肖科, 孫長峰, 等. 中性粒細胞與淋巴細胞比值聯合系統免疫炎癥指數評價乙肝相關肝細胞癌切除術后預后的價值. 中國普外基礎與臨床雜志, 2021, 28(8): 1056-1061.
7.	Greten FR, Grivennikov SI. Inflammation and cancer: triggers, mechanisms, and consequences. Immunity, 2019, 51(1): 27-41.
8.	Yang YM, Kim SY, Seki E. Inflammation and liver cancer: molecular mechanisms and therapeutic targets. Semin Liver Dis, 2019, 39(1): 26-42.
9.	Wolach O, Sellar RS, Martinod K, et al. Increased neutrophil extracellular trap formation promotes thrombosis in myeloproliferative neoplasms. Sci Transl Med, 2018, 10(436): eaan8292.
10.	劉克顏, 寧召臣. 血小板在腫瘤轉移中的作用. 中國生物化學與分子生物學報, 2022, 38(8): 1006-1014.
11.	王愛云, 曹玉珠, 韋忠紅, 等. 血小板促進腫瘤生長與轉移機制研究進展. 中國藥理學通報, 2018, 34(8): 1045-1049.
12.	朱明強, 丁佑銘. 肝癌微環境靶向與免疫治療的研究現狀. 臨床肝膽病雜志, 2022, 38(8): 1913-1917.
13.	Ethier JL, Desautels D, Templeton A, et al. Prognostic role of neutrophil-to-lymphocyte ratio in breast cancer: a systematic review and meta-analysis. Breast Cancer Res, 2017, 19(1): 2.
14.	Liu XB, Gao ZY, Zhang QH, et al. Preoperative neutrophil lymphocyte ratio can be used as a predictor of prognosis in patients with adenocarcinoma of the esophagogastric junction: a systematic review and meta analysis. Front Oncol, 2020, 10: 178.
15.	Mirili C, Guney IB, Paydas S, et al. Prognostic significance of neutrophil/lymphocyte ratio (NLR) and correlation with PET-CT metabolic parameters in small cell lung cancer (SCLC). Int J Clin Oncol, 2019, 24(2): 168-178.
16.	Johnson PJ, Dhanaraj S, Berhane S, et al. The prognostic and diagnostic significance of the neutrophil-to-lymphocyte ratio in hepatocellular carcinoma: a prospective controlled study. Br J Cancer, 2021, 125(5): 714-716.
17.	Schobert IT, Savic LJ, Chapiro J, et al. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as predictors of tumor response in hepatocellular carcinoma after DEB-TACE. Eur Radiol, 2020, 30(10): 5663-5673.
18.	Wang D, Bai N, Hu X, et al. Preoperative inflammatory markers of NLR and PLR as indicators of poor prognosis in resectable HCC. PeerJ, 2019, 7: e7132.
19.	Li H, Wang Z, Yang F, et al. Development and validation of a nomogram for predicting cancer-specific survival of surgical resected stage Ⅰ-Ⅱ adenosquamous carcinoma of the lung. J Surg Oncol, 2020, 121(6): 1027-1035.

1. 中華人民共和國國家衛生健康委員會. 原發性肝癌診療指南(2022年版). 傳染病信息, 2022, 35(1): 1-26.
2. 四川大學華西醫院肝癌MDT團隊. 肝細胞肝癌全程多學科規范化管理: 華西醫院多學科專家共識(第二版). 中國普外基礎與臨床雜志, 2020, 27(9): 1062-1077.
3. 閻龍, 戴朝六. 上皮-間質轉化與肝細胞癌炎癥微環境的關系研究. 中國普外基礎與臨床雜志, 2017, 24(7): 885-889.
4. Li Y, Wang WB, Yang L, et al. The combination of body composition conditions and systemic inflammatory markers has prognostic value for patients with gastric cancer treated with adjuvant chemoradiotherapy. Nutrition, 2022, 93: 111464. doi: 10.1016/j.nut.2021.111464.
5. Yang HJ, Guo Z, Yang YT, et al. Blood neutrophil-lymphocyte ratio predicts survival after hepatectomy for hepatocellular carcinoma: a propensity score-based analysis. World J Gastroenterol, 2016, 22(21): 5088-5095.
6. 斯瑩, 肖科, 孫長峰, 等. 中性粒細胞與淋巴細胞比值聯合系統免疫炎癥指數評價乙肝相關肝細胞癌切除術后預后的價值. 中國普外基礎與臨床雜志, 2021, 28(8): 1056-1061.
7. Greten FR, Grivennikov SI. Inflammation and cancer: triggers, mechanisms, and consequences. Immunity, 2019, 51(1): 27-41.
8. Yang YM, Kim SY, Seki E. Inflammation and liver cancer: molecular mechanisms and therapeutic targets. Semin Liver Dis, 2019, 39(1): 26-42.
9. Wolach O, Sellar RS, Martinod K, et al. Increased neutrophil extracellular trap formation promotes thrombosis in myeloproliferative neoplasms. Sci Transl Med, 2018, 10(436): eaan8292.
10. 劉克顏, 寧召臣. 血小板在腫瘤轉移中的作用. 中國生物化學與分子生物學報, 2022, 38(8): 1006-1014.
11. 王愛云, 曹玉珠, 韋忠紅, 等. 血小板促進腫瘤生長與轉移機制研究進展. 中國藥理學通報, 2018, 34(8): 1045-1049.
12. 朱明強, 丁佑銘. 肝癌微環境靶向與免疫治療的研究現狀. 臨床肝膽病雜志, 2022, 38(8): 1913-1917.
13. Ethier JL, Desautels D, Templeton A, et al. Prognostic role of neutrophil-to-lymphocyte ratio in breast cancer: a systematic review and meta-analysis. Breast Cancer Res, 2017, 19(1): 2.
14. Liu XB, Gao ZY, Zhang QH, et al. Preoperative neutrophil lymphocyte ratio can be used as a predictor of prognosis in patients with adenocarcinoma of the esophagogastric junction: a systematic review and meta analysis. Front Oncol, 2020, 10: 178.
15. Mirili C, Guney IB, Paydas S, et al. Prognostic significance of neutrophil/lymphocyte ratio (NLR) and correlation with PET-CT metabolic parameters in small cell lung cancer (SCLC). Int J Clin Oncol, 2019, 24(2): 168-178.
16. Johnson PJ, Dhanaraj S, Berhane S, et al. The prognostic and diagnostic significance of the neutrophil-to-lymphocyte ratio in hepatocellular carcinoma: a prospective controlled study. Br J Cancer, 2021, 125(5): 714-716.
17. Schobert IT, Savic LJ, Chapiro J, et al. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as predictors of tumor response in hepatocellular carcinoma after DEB-TACE. Eur Radiol, 2020, 30(10): 5663-5673.
18. Wang D, Bai N, Hu X, et al. Preoperative inflammatory markers of NLR and PLR as indicators of poor prognosis in resectable HCC. PeerJ, 2019, 7: e7132.
19. Li H, Wang Z, Yang F, et al. Development and validation of a nomogram for predicting cancer-specific survival of surgical resected stage Ⅰ-Ⅱ adenosquamous carcinoma of the lung. J Surg Oncol, 2020, 121(6): 1027-1035.

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中性粒細胞與淋巴細胞和血小板比值聯合評分對于肝細胞癌切除術后的預后預測價值

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