Significance of platelet count and platelet-based models for hepatocellular carcinoma recurrence
Significance of platelet count and platelet-based models for hepatocellular carcinoma recurrence
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血小板计数和基于血小板的模型对肝细胞癌复发的意义。
DOI：
10.3748/wjg.v21.i18.5607
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发表时间：
2015-05-14
影响因子：
4.3
通讯作者：
Liu, Chang
中科院分区：
文献类型：
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作者：
Pang, Qing;Zhang, Jing-Yao;Liu, Chang
目的：目的：探讨血小板计数（PLT）及11项血小板基础指标对肝细胞癌（HCC）术后复发的影响。术前数据，包括实验室生化结果，用于计算分析中包括的11项指标。我们进行了受试者工作特征曲线分析，以确定预测复发的最佳截止值。使用Kaplan-Meier生存曲线计算HCC复发的累积率，并通过对数秩检验分析差异。进行多变量分析以确定HCC复发、早期复发（术后一年内）和晚期复发的独立预测因素。为了获得更好的预后模型，基于PLT的指标在表示为二元和连续变量后分别进行分析。两个血小板无关的，经验证的HCC预后模型作为参考指标纳入分析。根据B型肝炎病毒感染状态、肝硬化和肿瘤大小对患者进行分层后，进行了额外的分析，以研究血小板在不同亚组中的意义。结果：在研究队列中，44.2%（76/172）的患者发生了肝癌复发，50.6%（87/172）在中位随访时间46个月内死亡。血小板计数和11种血小板相关模式中的5种是复发的显著易感因素（P < 0.05）。多因素分析显示，在临床参数中，腹水、PLT ≥ 148 × 10（9）/L、碱性磷酸酶≥ 116 U/L和肿瘤大小≥ 5 cm与HCC复发风险较高独立相关（P < 0.05）。独立和显著模型包括天冬氨酸转氨酶/PLT指数、基于四个因素的纤维化指数、纤维商、天冬氨酸转氨酶/PLT/γ-谷氨酰转肽酶/甲胎蛋白指数和PLT/年龄/碱性磷酸酶/甲胎蛋白/天冬氨酸转氨酶指数。早、晚期复发的危险因素不同，PLT及上述指标更倾向于影响晚期复发。PLT是唯一的预测复发的非肝癌患者，并不受肿瘤大小，这是一个关键的混杂因素，在我们的study.CONCLUSION：PLT和PLT为基础的非侵入性模型是有效的工具，用于预测术后复发，特别是晚期复发。需要更大的队列来验证我们的发现。
AIM: To explore the effects of platelet count (PLT) and 11 platelet-based indices on postoperative recurrence of hepatocellular carcinoma (HCC).METHODS: We retrospectively analyzed 172 HCC patients who were treated by partial hepatectomy. Preoperative data, including laboratory biochemical results, were used to calculate the 11 indices included in the analysis. We performed receiver operating characteristic curve analysis to determine the optimal cut-off values for predicting recurrence. Cumulative rates of HCC recurrence were calculated using Kaplan-Meier survival curves and differences were analyzed by log-rank tests. Multivariate analyses were performed to identify independent predictors of recurrence, early recurrence (within one year after surgery), and late recurrence in HCC. To obtain better prognostic models, PLT-based indices were analyzed separately after being expressed as binary and continuous variables. Two platelet-unrelated, validated HCC prognostic models were included in the analyses as reference indices. Additional analyses were performed after patients were stratified based on hepatitis B virus infection status, cirrhosis, and tumor size to investigate the significance of platelets in different subgroups.RESULTS: In the study cohort, 44.2% (76/172) of patients experienced HCC recurrence, and 50.6% (87/172) died during a median follow-up time of 46 mo. PLT and five of the 11 platelet-related models were significant predisposing factors for recurrence (P < 0.05). Multivariate analysis indicated that, among the clinical parameters, presence of ascites, PLT >= 148 x 10(9)/L, alkaline phosphatase >= 116 U/L, and tumor size >= 5 cm were independently associated with a higher risk of HCC recurrence (P < 0.05). Independent and significant models included the aspartate aminotransferase/PLT index, fibrosis index based on the four factors, fibro-quotient, aspartate aminotransferase/PLT/gamma-glutamyl transpeptidase/alpha-fetoprotein index, and the PLT/age/alkaline phosphatase/alphafetoprotein/aspartate aminotransferase index. There were different risk factors between early and late recurrences, and PLT and these indices were more inclined to influence late recurrence. PLT was only predictive of recurrence in non-cirrhotic HCC patients, and was not influenced by tumor size, which was a critical confounder in our study.CONCLUSION: PLT and PLT-based noninvasive models are effective tools for predicting postoperative recurrence, especially late recurrence. Larger cohorts are needed to validate our findings.