摘要
目的探讨术前系统免疫炎症指数(SII)预测肝细胞癌肝移植受者预后的作用。方法回顾性分析2014年1月1日—2020年9月1日在青岛大学附属医院行肝移植手术的263例肝细胞癌病人的临床资料,绘制受试者工作特征(ROC)曲线,确定最佳界值;Kaplan-Meier法绘制生存曲线,应用Cox比例风险回归模型进行影响肝细胞癌病人肝移植术后总生存时间的多因素分析。结果术前SII预测肝细胞癌肝移植受者术后生存的ROC曲线最佳界值为211.09,灵敏度0.738,特异度0.540,曲线下面积为0.678(95%CI=0.602~0.754)。根据最佳界值分为高SII组(SII≥211.09,n=139)、低SII组(SII<211.09,n=124),低SII组受者术后1、2、3年累计生存率分别为92.5%、86.9%、82.4%,高SII组受者分别为83.0%、66.0%、55.6%,两组比较差异有统计学意义(χ^(2)=15.280,P<0.001)。多因素分析显示,甲胎蛋白>400μg/L(HR=1.756,95%CI=1.026~3.007,P<0.05)、术中失血量≥2000 mL(HR=2.530,95%CI=1.468~4.359,P<0.01)、病理分化Ⅲ~Ⅳ级(HR=1.975,95%CI=1.085~3.594,P<0.05)、微血管癌栓阳性(HR=2.367,95%CI=1.277~4.388,P<0.01)和SII≥211.09(HR=1.882,95%CI=1.041~3.401,P<0.05)是肝细胞癌肝移植受者术后生存情况的独立危险因素。结论术前SII对肝细胞癌肝移植受者术后生存有一定预测价值。
Objective To investigate the value of preoperative systemic immune-inflammation index(SII)in predicting the prognosis of patients with hepatocellular carcinoma(HCC)after liver transplantation.Methods A retrospective analysis was performed on the clinical data of 263 patients with HCC who had undergone liver transplantation in The Affiliated Hospital of Qingdao University from January 1,2014 to September 1,2020.A receiver operating characteristic(ROC)curve was plotted to determine the optimal cut-off value.Survival curves were derived using the Kaplan-Meier method.A multivariable analysis was performed to identify factors affecting the overall survival of patients with HCC after liver transplantation with the use of the Cox proportional-hazards regression model.Results The ROC curve of preoperative SII for predicting survival after liver transplantation for HCC showed:optimal cut-off value,211.09;sensitivity,0.738;specificity,0.540;and area under the ROC curve,0.678(95%CI=0.602-0.754).According to the optimal cut-off value,patients were divided into high-SII group(SII≥211.09,n=139)and low-SII group(SII<211.09,n=124).The 1-,2-,and 3-year cumulative survival rates after operation in the low-SII group were 92.5%,86.9%,and 82.4%,respectively,while those in the high-SII group were 83.0%,66.0%,and 55.6%,respectively,with significant differences between the two groups(χ^(2)=15.280,P<0.01).The multivariable analysis showed that alpha-fetoprotein>400μg/L(HR=1.756,95%CI=1.026-3.007,P<0.05),intraoperative blood loss≥2000 mL(HR=2.530,95%CI=1.468-4.359,P<0.01),pathological differentiation ofⅢtoⅣgrades(HR=1.975,95%CI=1.085-3.594,P<0.05),the presence of tumor thrombus in microvessels(HR=2.367,95%CI=1.277-4.388,P<0.01),and SII≥211.09(HR=1.882,95%CI=1.041-3.401,P<0.05)were independent risk factors for poor survival after liver transplantation for HCC.Conclusion Preoperative SII is of predictive value for the survival of patients with HCC after liver transplantation.
作者
王雪
牛庆慧
荆雪
张琪
李晓宇
张翠萍
WANG Xue;NIU Qinghui;JING Xue;ZHANG Qi;LI Xiaoyu;ZHANG Cuiping(Department of Gastroenterology,The Affiliated Hospital of Qingdao University,Qingdao 266003,China)
出处
《青岛大学学报（医学版）》
CAS
2023年第1期68-72,共5页
Journal of Qingdao University(Medical Sciences)
基金
山东省医药卫生科技发展计划项目(20200303-0683)。
关键词
癌
肝细胞
肝移植
炎症
预后
carcinoma,hepatocellular
liver transplantation
inflammation
prognosis
