基于多种炎症反应标志物构建肝细胞癌患者预后评分系统的临床研究

肝癌电子杂志 ›› 2020, Vol. 7 ›› Issue (2): 28-34.

基于多种炎症反应标志物构建肝细胞癌患者预后评分系统的临床研究

冯志强¹, 杨子旋², 韩山山³, 商玉涛¹, 赵君会¹, 杨庆民¹, 吴洁莹¹, 盛军¹, 郭晓东^4,*

1 北京朝阳急诊抢救中心普外科,北京 100020;
2 湖南中医药大学医学院,湖南长沙 410000;
3 空军特色医学中心肝胆外科,北京 100080;
4 北京朝阳急诊抢救中心医务科,北京 100020

收稿日期:2020-03-20 出版日期:2020-06-30 发布日期:2020-07-23
通讯作者: ^* 郭晓东 E-mail: GXD5401@163.com
作者简介:冯志强,副主任医师,北京朝阳急诊抢救中心普外科。
基金资助:
国家自然科学基金(81341067)

Clinical study on the construction of prognostic scoring system for hepatocellular carcinoma patients based on a variety of inflammatory response markers

Feng Zhiqiang¹, Yang Zixuan², Han Shanshan³, Shang Yutao¹, Zhao Junhui¹, Yang Qingmin¹, Wu Jieying¹, Sheng Jun¹, Guo Xiaodong^4,*

1 Department of General Surgery,Beijing Chaoyang Emergency Rescue Center, Beijing 100020, China;
2 Medical College, Hunan University of Chinese Medicine, Changsha 410000, Hunan, China;
3 Department of Hepatobiliary Surgery, Air Force Characteristic Medical Center, Beijing 100080, China;
4 Department of Medical Affairs, Beijing Chaoyang Emergency Rescue Center,Beijing 100020, China

Received:2020-03-20 Online:2020-06-30 Published:2020-07-23

摘要/Abstract

摘要： 目的: 本研究基于中性粒细胞与淋巴细胞比值（neutrophils to lymphocytes ratio,NLR）、血小板与淋巴细胞比值（platelet to lymphocyte ratio,PLR）及淋巴细胞与单核细胞比值（lymphocyte to monocyte ratio,LMR）构建预测HCC肝切除术后患者生存率的炎症反应评分（inflammatory response score,IRS）。方法: 选取北京朝阳急诊抢救中心、空军特色医学中心在2013年5月至2019年1月收治的284例肝细胞癌（hepatocellular carcinoma,HCC）患者。采用ROC曲线获得NLR、PLR、LMR最佳截断值并构建NPL-IRS。通过时间-ROC评价NPL-IRS的有效性。结果: 284例患者随访时间3~43个月,随访（21.52±7.98）个月。随访末期,157例患者死亡,1年病死率24.6%、3年病死率55.3%。NLR、PLR、LMR的AUC分别为0.889、0.895、0.861;最佳截断值分别为2.34、98.74、3.43。NLR≤2.34、PLR≤98.74、LMR>3.43组患者的总体生存率高于对应组别（P<0.05）。肝硬化、多发肿瘤、血管侵犯、Ⅲ~Ⅳ期肿瘤、NPL-IRS-1分、NPL-IRS-2分、NPL-IRS-3分是HCC患者死亡的独立危险因素（P<0.05）。NPL-IRS的最佳截断值为1,AUC为0.794（95%CI=0.742~0.839）。时间-ROC曲线结果显示：NPL-IRS的AUC在任何时间段均高于NLR、PLR、LMR。结论: 基于NLR、PLR、LMR最佳截断值成功构建出NPL-IRS,该评分系统较单一的炎症反应标准物更能准确预测HCC患者预后。

关键词: 肝细胞癌, 炎症, 预后

Abstract: Objective: The inflammatory response score (IRS) was constructed based on the ratio of neutrophils to lymphocytes, the ratio of platelets to lymphocytes and the ratio of lymphocytes to monocytes to predict the survival rate of HCC patients after hepatectomy.Methods: 284 patients with HCC were selected from Beijing Chaoyang emergency rescue center and air force characteristic medical center from May 2013 to January 2019. The best truncation values of NLR, PLR and LMR were obtained by ROC curve and NPL-IRS was constructed.The validity of NPL-IRS was evaluated by time ROC.Results: 284 patients were followed up for 3~43 months, the follow-up time was (21.52 ±7.98) months. At the end of follow-up, 157 patients died, with one-year mortality of 24.6% and three-year mortality of 55.3%. The AUC of NLR, PLR and LMR were 0.889, 0.895 and 0.861 respectively, and the best truncation values were 2.34, 98.74 and 3.43 respectively. The overall survival rate of NLR≤2.34, PLR≤98.74, LMR>3.43 group was higher than that of the corresponding group (P < 0.05). Cirrhosis (yes), tumor number (multiple), vascular invasion (yes), tumor stage (Ⅲ~Ⅳ), NPL-IRS-1, NPL-IRS-2 and NPL-IRS-3 were the independent risk factors of death in HCC patients (P<0.05). The best truncation value of NPL-IRS was 1 and AUC was 0.794 (95% CI=0.742~0.839). The results of time ROC curve show that AUC of NPL-IRS is higher than that of NLR, PLR and LMR at any time.Conclusion: Based on the best truncation values of NLR, PLR and LMR, npl-irs was successfully constructed in this study, which can predict the prognosis of HCC patients more accurately than a single inflammatory response standard.

Key words: Hepatocellular carcinoma, Inflammation, Prognosis

冯志强, 杨子旋, 韩山山, 商玉涛, 赵君会, 杨庆民, 吴洁莹, 盛军, 郭晓东. 基于多种炎症反应标志物构建肝细胞癌患者预后评分系统的临床研究[J]. 肝癌电子杂志, 2020, 7(2): 28-34.

Feng Zhiqiang, Yang Zixuan, Han Shanshan, Shang Yutao, Zhao Junhui, Yang Qingmin, Wu Jieying, Sheng Jun, Guo Xiaodong. Clinical study on the construction of prognostic scoring system for hepatocellular carcinoma patients based on a variety of inflammatory response markers[J]. Electronic Journal of Liver Tumor, 2020, 7(2): 28-34.

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