The Prognostic Value of aspartate aminotransferase to lymphocyte ratio and systemic immune-inflammation index for Overall Survival of Hepatocellular Carcinoma Patients Treated with palliative Treatments
The Prognostic Value of aspartate aminotransferase to lymphocyte ratio and systemic immune-inflammation index for Overall Survival of Hepatocellular Carcinoma Patients Treated with palliative Treatments
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DOI：
10.7150/jca.30663
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发表时间：
2019-01-01
影响因子：
3.9
通讯作者：
Wu, Xiang-Yuan
中科院分区：
文献类型：
--
作者：
Zhao, Li-Yun;Yang, Dong-Dong;Wu, Xiang-Yuan
背景：据报道，淋巴细胞在宿主抗癌免疫反应中发挥重要作用，并影响肿瘤预后。很少有研究关注天冬氨酸转氨酶（AST）与淋巴细胞比值（ALRI）、天冬氨酸转氨酶与血小板计数比值指数（APRI）和全身免疫炎症指数（SII）在接受姑息治疗的肝细胞癌（HCC）中的预后价值。方法：对598例接受姑息治疗的HCC患者进行回顾性分析。我们将患者随机分为训练队列（429 名患者）和验证队列 I（169 名患者）。使用受试者工作特征 (ROC) 曲线来确定训练队列中 ALRI、APRI 和 SII 的最佳截止值，并在验证队列 I 中进一步验证这些值。还分析了 ALRI 与其他临床病理因素之间的相关性。建立了包括 ALRI 在内的预后列线图。我们通过两个独立队列验证了 ALRI、SII 和 APRI 的预后价值，验证队列 II 包括 82 名接受 TACE 治疗的 HCC 患者，验证队列 III 包括 150 名接受根治性切除治疗的 HCC 患者。在训练队列和所有验证队列中，采用Kaplan-Meier方法进行单因素分析，并采用Cox比例风险回归模型进行多因素分析，以确定独立的预后因素。结果：通过ROC曲线分析，训练队列中ALRI、APRI和SII的阈值分别为86.3、1.37和376.4。相关分析显示，ALRI>86.3与Child-Pugh B&C、门静脉肿瘤血栓（PVTT）和腹水发生率较高显着相关（P < 0.05）。相应地，Child-Pugh B&C、PVTT、腹水的 HCC 患者 ALRI 水平明显高于 Child-Pugh A、无 PVTT、无腹水的 HCC 患者（P < 0.001）。在训练队列和验证队列I、II、III中，ALRI>86.3患者的OS明显短于ALRI患者
Background: Lymphocytes were reported to play a significant part in host anticancer immune responses and influence tumour prognosis. Few studies have focused on the prognostic values of aspartate aminotransferase (AST) to lymphocyte ratio (ALRI), aspartate aminotransferase to platelet count ratio index (APRI) and systemic immune-inflammation index (SII) in hepatocellular carcinoma (HCC) treated with palliative treatments.Methods: Five hundred and ninety-eight HCC patients treated with palliative therapies were retrospectively analysed. We randomly assigned patients into the training cohort (429 patients) and the validation cohort I (169 patients). Receiver operating characteristic (ROC) curves were used to identify the best cut-off values for the ALRI, APRI and SII in the training cohort and the values were further validated in the validation cohort I. Correlations between ALRI and other clinicopathological factors were also analysed. A prognostic nomogram including ALRI was established. We validated the prognostic value of the ALRI, SII and APRI with two independent cohorts, the validation cohort II of 82 HCC patients treated with TACE and the validation cohort III of 150 HCC patients treated with curative resection. In the training cohort and all the validation cohorts, univariate analyses by the method of Kaplan-Meier and multivariate analysis by Cox proportional hazards regression model were carried out to identify the independent prognostic factors.Results: The threshold values of ALRI, APRI and SII were 86.3, 1.37 and 376.4 respectively identified by ROC curve analysis in the training cohort. Correlation analysis showed that ALRI>86.3 was greatly associated with higher rates of Child-Pugh B&C, portal vein tumor thrombosis (PVTT) and ascites (P < 0.05). Correspondingly, ALRI level of HCC patients with Child-Pugh B&C, PVTT and ascites was evidently higher than that of HCC patients with Child-Pugh A, without PVTT and without ascites (P < 0.001). In the training cohort and the validation cohort I, II, III, the OS of patients with ALRI >86.3 was obviously shorter than patients with ALRI