外周血PLR和CA19-9/GGT对肝癌根治性切除术后复发的预测价值

Predictive value of peripheral blood PLR and the CA19-9/GGT ratio for recurrence after radical resection of hepatocellular carcinoma

摘要:

目的 分析外周血血小板/淋巴细胞比值（PLR）、糖类抗原/γ-谷氨酰转移酶（CA19-9/GGT）比值与肝癌根治性切除术后复发的关系。方法 选取2020年6月—2023年6月在西南医科大学附属医院行肝癌根治性切除手术的患者103例，并进行为期1年的随访，按随访情况分为复发组（52例）和非复发组（51例），术前检测两组患者外周血PLR和CA19-9/GGT比值，影响患者术后复发的因素采用多因素一般Logistic回归分析，以受试者工作特征（ROC）曲线分析其对肝癌根治性切除术后复发的预测价值。结果 复发组微血管侵犯率、术后甲胎蛋白（AFP）未转阴率、发现方式为症状、肿瘤包膜不完整率、PLR及CA19-9/GGT比值均高于未复发组（P <0.05）。多因素一般Logistic回归分析结果显示，PLR水平高［O^R=1.059（95% CI：1.029，1.090）］、CA19-9/GGT比值高［O^R=9.027（95% CI：3.252，26.069）］、微血管侵犯［O^R=3.819（95% CI：1.112，13.121）］、术后AFP未转阴［O^R=4.630（95% CI：1.299，16.499）］、发现方式为症状［O^R=4.115（95% CI：1.143，14.807）、肿瘤包膜不完整［O^R=4.101（95% CI：1.045，16.091）］均为肝癌根治性切除术后复发的危险因素（P <0.05）。ROC曲线分析结果显示，PLR水平和CA19-9/GGT比值联合预测肝癌患者术后复发的曲线下面积为0.881，敏感性为73.11%（95% CI：0.587，0.840），特异性为92.16%（95% CI：0.803，0.975）。结论 外周血PLR和CA19-9/GGT比值与肝癌根治性切除术后复发有关，术前测定外周血PLR和CA19-9/GGT比值可预测肝癌术后复发的情况。

Abstract:

Objective To analyze the associations of the peripheral blood platelet-to-lymphocyte ratio (PLR) and carbohydrate antigen 19-9-to-gamma-glutamyl transferase ratio (CA19-9/GGT) with recurrence after radical resection of hepatocellular carcinoma (HCC).Methods A total of 103 patients who underwent radical resection of HCC at the Affiliated Hospital of Southwest Medical University between June 2020 and June 2023 were followed for 1 year. According to follow-up outcomes, the patients were divided into a recurrence group (n = 52) and a non-recurrence group (n = 51). Preoperative peripheral blood PLR and CA19-9/GGT were measured in both groups. Multivariable logistic regression was used to analyze factors associated with postoperative recurrence, and receiver operating characteristic (ROC) curves were used to evaluate the predictive value of PLR and CA19-9/GGT.Results The recurrence group had higher rates of microvascular invasion, postoperative alpha-fetoprotein (AFP) negativity, symptomatic detection, and complete tumor capsule, as well as higher PLR and CA19-9/GGT values, than the non-recurrence group (P < 0.05). Multivariable logistic regression showed that elevated PLR [O^R = 1.059 (95% CI: 1.029, 1.090) ], elevated CA19-9/GGT [O^R = 9.027 (95% CI: 3.252, 26.069) ], microvascular invasion [O^R = 3.819 (95% CI: 1.112, 13.121) ], failure of AFP to become negative postoperatively [O^R = 4.630 (95% CI: 1.299, 16.499) ], symptomatic detection [O^R = 4.115 (95% CI: 1.143, 14.807) ], and an incomplete tumor capsule [O^R = 4.101 (95% CI: 1.045, 16.091) ] were risk factors for recurrence after radical resection of HCC (P < 0.05). The combination of PLR and CA19-9/GGT predicted postoperative recurrence with an area under the ROC curve of 0.881, a sensitivity of 73.11% (95% CI: 0.587, 0.840), and a specificity of 92.16% (95% CI: 0.803, 0.975).Conclusion Peripheral blood PLR and CA19-9/GGT are associated with recurrence after radical resection of HCC. Preoperative measurement of these indices may help predict postoperative recurrence.