摘要
目的评估术前白蛋白/球蛋白比值(albumin/globulin ratio,AGR)在肝癌射频消融病人预后中的价值和意义。方法回顾性分析华中科技大学同济医学院附属荆州医院肝胆外科2011年12月至2018年9月间接受射频消融的原发性肝癌病人资料。根据受试者的工作特征曲线(ROC曲线)确定AGR最佳截点值,进而根据该值将所有病人分为高AGR组和低AGR组。单因素、多因素分析及亚组分析探讨AGR与病人临床病理特征及预后的关系。结果 AGR最佳截点值为1.27。AGR与病人年龄、癌栓、肝硬化和腹水密切相关。单因素及多因素分析显示影响病人总体生存时间的独立危险因素为:术前腹水[风险比(HR):1.979,95%置信区间(CI):(1.035,3.786),P=0.039];肿瘤直径[HR:2.839,95%CI:(1.421,5.671),P=0.003];癌栓[HR:2.617,95%CI:(1.249,5.482),P=0.011];白蛋白[HR:0.521,95%CI:(0.305,0.890),P=0.017]及AGR[HR:0.333,95%CI:(0.187,0.593),P<0.001]。而影响术后病人无瘤生存时间的独立危险因素为肝硬化[HR:2.297,95%CI:(1.261,4.184),P=0.007];乙型肝炎[HR:2.586,95%CI:(1.305,5.127),P=0.006];癌栓[HR:2.385,95%CI:(1.017,5.594),P=0.046]及AGR[HR:0.570,95%CI:(0.345,0.942),P=0.028]。亚组分析显示:AGR对大小肝癌病人术后总体生存时间均产生明显影响;而对无瘤生存时间而言,AGR主要影响非肝硬化病人。结论 AGR是影响原发性肝癌射频消融术后病人临床预后的独立危险因素。由于AGR简单、客观、容易获得且非有创等特点,其可常规作为原发性肝癌病人术前评估的指标。
Objective To evaluate the predictive value of albumin/globulin ratio (AGR) in overall survival time (OS)and relapse-free survival time in hepatocellular carcinoma (HCC) patients subject to radiofrequency ablation. Methods The retrospective study included a total of 192 postoperative HCC patients between December 2011 and September 2018.The receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off value.All the patients were divided into two groups based on the value,namely high-AGR group and low-AGR group.Univariate,multivariate and subgroup analyses were used to evaluate the predictive value. Results The optimal cut-off value of AGR was 1.27.AGR was significantly correlated to age,cancer embolus,liver cirrhosis and ascitic fluid.Preoperative ascitic fluid [ HR :1.979,95% CI :(1.035,3.786),P=0.039],tumor size [ HR :2.839,95% CI :(1.421,5.671),P=0.003],cancer embolus [ HR :2.617,95% CI :(1.249, 5.482 ),P=0.011],albumin [ HR :0.521,95% CI :(0.305,0.890),P=0.017] and AGR [ HR :0.333,95% CI :(0.187,0.593),P<0.001] were independent predictors of OS via univariate and multivariate survival analyses.However,liver cirrhosis [ HR :2.297,95% CI :(1.261,4.184),P=0.007],HBV infection [ HR :2.586,95% CI :(1.305,5.127),P=0.006],cancer embolus [ HR :2.385,95% CI :( 1.017 ,5.594),P=0.046] and AGR [ HR :0.570,95% CI :(0.345,0.942),P=0.028] functioned as independent risk variables for predicting relapse-free survival time.Moreover,AGR showed a superior prognostic value for OS despite tumor size.However,AGR mainly affected the postoperative relapse-free survival time in the patents with liver cirrhosis. Conclusion AGR might serve as an effective biomarker to evaluate the prognosis of HCC patients after radiofrequency ablation.Based on the results,AGR,characterized with easy accessibility,objectivity and noninvasiveness,should be included in the routine preoperative assessment of HCC.
作者
邓岩
王帅
喻晓
霍成龙
孙振纲
Deng Yan;Wang Shuai;Yu Xiao;Huo Chenglong;Sun Zhengang(Department of Hepatobiliary Surgery,Jingzhou Hospital,Tongji Medical College,Huazhong University of Science and Technology,Hubei Jingzhou 434020,China)
出处
《腹部外科》
2019年第2期112-118,共7页
Journal of Abdominal Surgery
基金
湖北省医学领军人才培养工程专项经费[鄂卫生计省发(2013)第4号]
关键词
白蛋白/球蛋白比值
原发性肝癌
射频消融
预后
Albumin/globulin ratio
Hepatocellular carcinoma
Radiofrequency ablation
Prognosis
