中性粒细胞与淋巴细胞和血小板比值联合评分对于肝细胞癌切除术后的预后预测价值_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

周宇 ¹ , 刘卓然 ¹ , 梅名强 ¹ ,  付文广 ^1,2

1. ;
2. ;

Corresponding author：

付文广, Email: fuwg@swmu.edu.cn

Keywords：

肝细胞癌; 中性粒细胞; 淋巴细胞; 血小板; 预后

DOI：

10.7507/1007-9424.202304060

Video：

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目的探讨中性粒细胞与淋巴细胞比值（neutrophil to lymphocyte ratio，NLR）联合中性粒细胞与血小板比值（neutrophil to platelet ratio，NPR）评分对于肝细胞癌切除术后的预后预测价值。方法本研究回顾性收集了2013年7月至2021年12月期间于西南医科大学附属医院肝胆胰外科住院并接受手术切除且符合本研究纳入标准的肝细胞癌患者的临床病理资料，同时采用单因素和多因素Cox比例风险回归分析影响肝细胞癌手术后总生存的危险因素并建立列线图预测模型。结果本研究共纳入了符合标准的肝细胞癌患者283例。NLR、NPR 及NLR联合NPR 评分判断肝细胞癌术后总生存率的受试者操作特征曲线下面积（95%可信区间）分别为 0.643（0.579，0.708）、0.646（0.582，0.710）及0.703（0.642，0.763）。多因素分析结果显示，乙肝病毒感染（P=0.047）、丙氨酸转氨酶＞40 U/L（P=0.012）、甲胎蛋白＞400 μg/L（P=0.001）、肿瘤最大直径＞5 cm（P=0.011）、肿瘤数目多个（P=0.010）、NLR 联合 NPR 评分 1/2 分（P=0.001/P＜0.001）为肝细胞癌术后患者总生存的危险因素，基于这 6 个因素建立的列线图预测模型预测 5 年总生存率的受试者操作特征曲线下面积（95%可信区间）为 0.749（0.675，0.823）。结论本研究结果提示，患者术前NLR联合NPR评分有作为评估肝细胞癌切除术后患者的预后预测指标的潜在价值。

Citation： 周宇, 刘卓然, 梅名强, 付文广. 中性粒细胞与淋巴细胞和血小板比值联合评分对于肝细胞癌切除术后的预后预测价值. 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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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.	斯莹, 肖科, 孙长峰, 等. 中性粒细胞与淋巴细胞比值联合系统免疫炎症指数评价乙肝相关肝细胞癌切除术后预后的价值. 中国普外基础与临床杂志, 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.	刘克颜, 宁召臣. 血小板在肿瘤转移中的作用. 中国生物化学与分子生物学报, 2022, 38(8): 1006-1014.
11.	王爱云, 曹玉珠, 韦忠红, 等. 血小板促进肿瘤生长与转移机制研究进展. 中国药理学通报, 2018, 34(8): 1045-1049.
12.	朱明强, 丁佑铭. 肝癌微环境靶向与免疫治疗的研究现状. 临床肝胆病杂志, 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. 中华人民共和国国家卫生健康委员会. 原发性肝癌诊疗指南(2022年版). 传染病信息, 2022, 35(1): 1-26.
2. 四川大学华西医院肝癌MDT团队. 肝细胞肝癌全程多学科规范化管理: 华西医院多学科专家共识(第二版). 中国普外基础与临床杂志, 2020, 27(9): 1062-1077.
3. 阎龙, 戴朝六. 上皮-间质转化与肝细胞癌炎症微环境的关系研究. 中国普外基础与临床杂志, 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. 斯莹, 肖科, 孙长峰, 等. 中性粒细胞与淋巴细胞比值联合系统免疫炎症指数评价乙肝相关肝细胞癌切除术后预后的价值. 中国普外基础与临床杂志, 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. 刘克颜, 宁召臣. 血小板在肿瘤转移中的作用. 中国生物化学与分子生物学报, 2022, 38(8): 1006-1014.
11. 王爱云, 曹玉珠, 韦忠红, 等. 血小板促进肿瘤生长与转移机制研究进展. 中国药理学通报, 2018, 34(8): 1045-1049.
12. 朱明强, 丁佑铭. 肝癌微环境靶向与免疫治疗的研究现状. 临床肝胆病杂志, 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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中性粒细胞与淋巴细胞和血小板比值联合评分对于肝细胞癌切除术后的预后预测价值

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