术前中性粒细胞 / 淋巴细胞比值对小肝癌患者并发微血管 浸润的预测价值
| 作者: |
1任家书,
1马秀现,
1李健,
1黄向上
1 郑州大学第一附属医院 肝胆胰外科，河南 郑州 450052 |
| 通讯: |
马秀现
Email: maxiuxian2013@126.com |
| DOI: | 10.3978/.2018.07.007 |
摘要
目的：评价术前外周血中性粒细胞 / 淋巴细胞比值（NLR）对小肝癌患者并发微血管浸润（MVI）的预测价值。
方法：回顾性分析确诊的 50 例小肝癌并发 MVI 患者与随机选取同期确诊的 90 例小肝癌未并发 MVI 患者的临床资料。根据受试者工作特征（ROC）曲线确定 NLR 诊断 MVI 的临界值，采用单因素分析及非条件 Logistic 回归模型分析小肝癌患者并发 MVI 的危险因素。
结果：ROC 曲线分析得到 NLR 诊断 MVI 的临界值为 3.27，对应的敏感度为 0.480，特异度为 0.767，曲线下面积（AUC）为 0.613（95% CI=0.511~0.715，P=0.027）。单因素分析显示，并发 MVI 患者中，AFP>25 ng/mL、肿瘤最大直径 >3 cm、NLR>3.27 的比例明显高于在未并发 MVI 患者中的比例（均P<0.05）；非条件 Logistic 回归模分析显示 NLR、AFP、肿瘤最大直径是小肝癌患者并发 MVI 的独立危险因素（均 P<0.05）。此外，NLR ≤ 3.27 的患者 AFP、中性粒细胞、淋巴细胞、血小板、白蛋白及肿瘤最大直径方面均优于 NLR>3.27 患者（均 P<0.05）。
结论：术前 NLR 值是影响小肝癌患者并发 MVI 的独立危险因素之一，可作为一种临床上简便易行的预测指标，NLR>3.27 者发生 MVI 的可能性大。
关键词：
癌，肝细胞；肿瘤侵润；微血管；炎症；危险因素
方法：回顾性分析确诊的 50 例小肝癌并发 MVI 患者与随机选取同期确诊的 90 例小肝癌未并发 MVI 患者的临床资料。根据受试者工作特征（ROC）曲线确定 NLR 诊断 MVI 的临界值，采用单因素分析及非条件 Logistic 回归模型分析小肝癌患者并发 MVI 的危险因素。
结果：ROC 曲线分析得到 NLR 诊断 MVI 的临界值为 3.27，对应的敏感度为 0.480，特异度为 0.767，曲线下面积（AUC）为 0.613（95% CI=0.511~0.715，P=0.027）。单因素分析显示，并发 MVI 患者中，AFP>25 ng/mL、肿瘤最大直径 >3 cm、NLR>3.27 的比例明显高于在未并发 MVI 患者中的比例（均P<0.05）；非条件 Logistic 回归模分析显示 NLR、AFP、肿瘤最大直径是小肝癌患者并发 MVI 的独立危险因素（均 P<0.05）。此外，NLR ≤ 3.27 的患者 AFP、中性粒细胞、淋巴细胞、血小板、白蛋白及肿瘤最大直径方面均优于 NLR>3.27 患者（均 P<0.05）。
结论：术前 NLR 值是影响小肝癌患者并发 MVI 的独立危险因素之一，可作为一种临床上简便易行的预测指标，NLR>3.27 者发生 MVI 的可能性大。
Value of preoperative neutrophil to lymphocyte ratio for prediction of microvascular invasion in patients with small hepatocellular carcinoma
CorrespondingAuthor:Xiuxian MA Email: maxiuxian2013@126.com
Abstract
Objective: To evaluate the value of neutrophil to lymphocyte ratio (NLR) in predicting microvascular invasion (MVI) in patients with small hepatocellular carcinoma (HCC).
Methods: The clinical data of 50 patients diagnosed as small HCC with MVI from June 2012 to June 2017, and 90 patients by random pick from those diagnosed as small HCC without MVI in the same period were retrospectively analyzed. Th e cut-off value of NLR for diagnosis of MVI was calculated by using receiver operating characteristic (ROC) curve. The risk factors for MVI in patients with small HCC were determined by univariate and unconditional Logistic regression analyses.
Results: The cut-off value of NLR for diagnosis of MVI was 3.27, with sensitivity of 0.480, specificity of 0.767 and area under the curve (AUC) of 0.613 (95% CI=0.511 0.715, P=0.027). Univariate analysis showed that the proportions of cases with AFP>25 ng/mL, maximum tumor diameter larger than 3 cm and NLR>3.27 in patients with MVI were singinifcantly higher than those in patients without MVI (all P<0.05); unconditional logistic regression analysis revealed that NLR, AFP level and maximum tumor diameter were independent risk factors for small HCC with complicated MVI (all P<0.05). In addition, the variables that included AFP, neutrophil, lymphocyte, blood platelet, albumin and maximum tumor diameter in patients with NLR≤3.27 were significantly superior to those in patients with NLR>3.27 (all P<0.05).
Conclusion: Preoperative NLR value is one of the independent risk factors for complicated MVI in patients with small HCC, and it can be a simple to use
Keywords：
Carcinoma
Hepatocellular; Neoplasm Invasiveness; Microvessels; Inflammation; Risk Factors
Methods: The clinical data of 50 patients diagnosed as small HCC with MVI from June 2012 to June 2017, and 90 patients by random pick from those diagnosed as small HCC without MVI in the same period were retrospectively analyzed. Th e cut-off value of NLR for diagnosis of MVI was calculated by using receiver operating characteristic (ROC) curve. The risk factors for MVI in patients with small HCC were determined by univariate and unconditional Logistic regression analyses.
Results: The cut-off value of NLR for diagnosis of MVI was 3.27, with sensitivity of 0.480, specificity of 0.767 and area under the curve (AUC) of 0.613 (95% CI=0.511 0.715, P=0.027). Univariate analysis showed that the proportions of cases with AFP>25 ng/mL, maximum tumor diameter larger than 3 cm and NLR>3.27 in patients with MVI were singinifcantly higher than those in patients without MVI (all P<0.05); unconditional logistic regression analysis revealed that NLR, AFP level and maximum tumor diameter were independent risk factors for small HCC with complicated MVI (all P<0.05). In addition, the variables that included AFP, neutrophil, lymphocyte, blood platelet, albumin and maximum tumor diameter in patients with NLR≤3.27 were significantly superior to those in patients with NLR>3.27 (all P<0.05).
Conclusion: Preoperative NLR value is one of the independent risk factors for complicated MVI in patients with small HCC, and it can be a simple to use