围手术期CAR 水平对肝动脉 化疗栓塞患者预后的影响

Significance of perioperative CRP/albumin ratio in predicting prognosis of HCC patients with hepatic arterial chemoembolization

摘要:

目的 探讨围手术期C 反应蛋白（CRP）与白蛋白（Alb）比值（CAR）对肝动脉化疗栓塞（TACE） 患者预后的影响。方法 选取河南省郑州人民医院收治的126 例行TACE 术治疗的肝癌患者，检测其术前血 清CRP 和Alb 水平，计算CAR。分析不同CAR 水平肝癌患者术后短期恢复情况或复发转移情况的差异。 纳入一般临床资料，分别采用单因素及多因素Cox 回归分析CAR 对肝癌患者经TACE 治疗后生存期的影 响。结果 所有患者根据CAR 最佳截点0.036，分为高CAR 组（70 例）和低CAR 组（56 例）。高CAR 组 患者短期恢复情况及术后住院时间与低CAR 组比较，差异无统计学意义（P >0.05），而术后并发症发生率高 于低CAR 组（P <0.05）。高CAR 组的复发或转移率高于低CAR 组（P <0.05）。单因素和多因素Cox 回归 分析发现，术前CAR[Hl ^ R=3.592（95%CI ：1.809，4.736），P =0.037]、Child-Pugh 分级[Hl ^ R=3.555（95%CI ： 1.201，5.742），P =0.037]、最大肿瘤直径[Hl ^ R=2.288（95%CI ：1.033，6.068），P =0.041] 及血管浸润比例 [Hl ^ R=3.297（95%CI ：1.171，9.283），P =0.024] 是肝癌患者TACE 术后生存期的独立影响因素。结论 TACE 术前高CAR 水平肝癌患者相对于低CAR 患者术后并发症、术后复发转移风险较高，且生存期相对较短，可 以作为肝癌患者TACE 术前的预后评估参考性指标之一。

Abstract:

Objective To investigate the effect of perioperative C-reactive protein (CRP) to albumin (Alb) ratio (CAR) on the prognosis of hepatocellular carcinoma (HCC) patients receiving transcatheter arterial chemoembolization (TACE). Methods A total of 126 HCC patients treated by TACE in Zhengzhou People’s Hospital were collected. Serum CRP and Alb were detected and CAR was calculated. The short-time postoperative recovery and the recurrence or metastasis of the patients in different CAR groups were compared and analyzed. Univariate and multivariate Cox regression analyses were conducted to analyze the effect of CAR on the postoperative survival time of TACE-treated patients. Results According to the best cut-off point of CAR (0.036), all HCC patients were divided into a high-CAR group (70 cases) and a low-CAR group (56 cases). The short-term postoperative recovery and postoperative hospital stay were not significantly different between the two groups (P > 0.05), but the incidence of postoperative complications of the high-CAR group was higher than that of the low-CAR group (P < 0.05). The rate of recurrence or metastasis in the high-CAR group was higher than that in the low-CAR group (P < 0.05). Preoperative CAR [Hl ^ R = 3.592 (95% CI: 1.809, 4.736), P = 0.037], Child-Pugh classification [Hl ^ R = 3.555 (95% CI: 1.201, 5.742), P = 0.037], the maximum tumor diameter [Hl ^ R = 2.288 (95% CI: 1.033, 6.068), P = 0.041] and vascular infiltration ratio [Hl ^ R =3.297 (95% CI: 1.171, 9.283), P = 0.024] were the independent effect factors of survival time after TACE in the HCC patients. Conclusions Compared with the HCC patients with low CAR level before TACE treatment, those with high CAR level have higher risks of postoperative complications and recurrence or metastasis, and the survival time is relatively short. Therefore, CAR before TACE treatment could be used as one of the prognostic indicators for HCC patients.