A novel and accurate predictor of survival for patients with hepatocellular carcinoma after surgical resection: the neutrophil to lymphocyte ratio (NLR) combined with the aspartate aminotransferase/platelet count ratio index (APRI).
A novel and accurate predictor of survival for patients with hepatocellular carcinoma after surgical resection: the neutrophil to lymphocyte ratio (NLR) combined with the aspartate aminotransferase/platelet count ratio index (APRI).
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DOI：
10.1186/s12885-016-2189-1
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发表时间：
2016-02-22
期刊：
影响因子：
3.8
通讯作者：
Hua YP
中科院分区：
文献类型：
--
作者：
Ji F;Liang Y;Fu SJ;Guo ZY;Shu M;Shen SL;Li SQ;Peng BG;Liang LJ;Hua YP
肝细胞癌（HCC）的发生发展在很大程度上取决于炎症状态、免疫状态、病毒感染和肝纤维化等非肿瘤因素。各种基于炎症的预后评分与HCC患者的生存相关，如中性粒细胞/淋巴细胞比率（NLR）、血小板/淋巴细胞比率（PLR）和预后营养指数（PNI）。天冬氨酸转氨酶/血小板计数比率指数（APRI）被认为是肝纤维化和肝硬化的生物标志物。本研究旨在评估这些指标预测肝癌患者根治性肝切除术后生存率的能力，并探讨APRI结合已建立的炎症预后评分的预后准确性。回顾性收集了321例接受根治性切除术的HCC患者的数据。分析术前NLR、PLR、PNI、APRI及临床病理指标。采用单因素和多因素分析方法，分析上述因素对无病生存期（DFS）和总生存期（OS）的预测价值。单因素分析显示NLR、PLR、PNI和APRI与肝癌根治性切除患者的DFS和OS显著相关。多因素分析显示，NLR和APRI上级优于PLR和PNI，且均与DFS和OS独立相关，术前NLR >2或APRI >1.68预示肝癌切除术后预后不良。此外，NLR联合APRI的预测范围比单独测量更敏感。术前NLR和APRI是HCC患者手术切除后DFS和OS的独立预测因子。NLR或APRI水平越高，HCC患者预后越差。有趣的是，结合NLR和APRI增加了测试的预后准确性。
The occurrence and development of hepatocellular carcinoma (HCC) depends largely on such non-tumor factors as inflammatory condition, immune state, viral infection and liver fibrosis. Various inflammation-based prognostic scores have been associated with survival in patients with HCC, such as the neutrophil/lymphocyte ratio (NLR), the platelet/lymphocyte ratio (PLR) and the prognostic nutritional index (PNI). The aspartate aminotransferase/platelet count ratio index (APRI) is thought to be a biomarker of liver fibrosis and cirrhosis. This study aims to evaluate the ability of these indices to predict survival in HCC patients after curative hepatectomy, and probe the increased prognostic accuracy of APRI combined with established inflammation-based prognostic scores. Data were collected retrospectively from 321 patients who underwent curative resection for HCC. Preoperative NLR, PLR, PNI, APRI and clinico-pathological variables were analyzed. Univariate and multivariate analyses were performed to identify the predictive value of the above factors for disease-free survival (DFS) and overall survival (OS). Univariate analysis showed that NLR, PLR, PNI and APRI were significantly associated with DFS and OS in HCC patients with curative resection. Multivariate analysis showed that NLR and APRI were superior to PLR and PNI, and both were independently correlated with DFS and OS. Preoperative NLR >2 or APRI >1.68 predicted poor prognosis of patients with HCC after hepatectomy. Furthermore, the predictive range of NLR combined with APRI was more sensitive than that of either measure alone. Preoperative NLR and APRI are independent predictors of DFS and OS in patients with HCC after surgical resection. Higher levels of NLR or APRI predict poorer outcomes in HCC patients. Intriguingly, combining NLR and APRI increases the prognostic accuracy of testing.