摘要目的 探讨术前加术后中性粒细胞-淋巴细胞比值(PP-NLR)对原发性肝细胞癌肝部分切术后患者预后的预测情况,从而进一步指导临床治疗.方法 回顾性分析2014年12月至2018年3月清华大学附属北京清华长庚医院肝胆外科收治的44例肝部分切除术患者临床资料.根据临界值,术前和术后高NLR分别赋值为l,低NLR分别赋值为0.术前NLR+术后NLR=0/1/2,将术前NLR+术后NLR=0/1归于同一组,术前NLR+术后NLR=2归于一组.用Kaplan-Meier方法计算无复发生存率和总生存率,log-rank检验比较组间差异.Cox比例风险模型确定危险因素.结果 对不同PP-NLR水平的临床病理资料比较发现,术前和术后的NLR在PP-NLR =2组高于PP-NLR=1/0组,差异有统计学意义(P＜0.05).单因素分析表明PP-NLR(HR=3.495,95％CI:1.054～ 11.589,P＜0.05)和分化程度(HR=3.995,95％CI:1.050～ 15.198,P＜0.05)是影响术后总体生存的危险因素,而单独的术前NLR和术后NLR不是影响总体生存的危险因素.多因素分析表明PP-NLR(HR=4.733,95％CI:1.320～16.966,P＜0.05)和分化程度(HR=6.310,95％CI:1.456～27.344,P＜0.05)是影响术后总体生存的独立危险因素.结论 PP-NLR考虑到了术前、术后整个治疗周期的全身免疫状态,相较于单纯的术前和术后NLR预测预后更为全面、效能更高.

abstractsObjective To investigate the preoperative plus postoperative neutrophil-lymphocyte ratio (PP-NLR) predicts the outcomes of hepatocellular carcinoma after hepatectomy.Methods The clinical data of 44 patients with partial hepatectomy in the Hepatobiliary Surgery,Beijing Tsinghua Changgung Hospital,Tsinghua University,from December 2014 to March 2018 were retrospectively analyzed.According to the cut-off value,the high NLR is assigned a value of 1 before and after surgery,and the low NLR is assigned a value of 0.Preoperative NLR plus postoperative NLR =0/1/2.The preoperative NLR plus postoperative NLR=0/1 was assigned to one group,and the preoperative NLR plus postoperative NLR=2 was attributed to one group.Recurrence-free survival (RFS) and overall survival (OS) were evaluated by the Kaplan-Meier method,with comparisons using the log-rank test.The Cox proportional hazard model is used for univariate and multivariate analysis.Results Comparison of clinical and pathological data of different PP-NLR,the preoperative and postoperative NLR was higher in the PP-NLR=2 group than in the PP-NLR=l/0 group,and the difference was significant (P＜0.05).Univariate analysis showed that PP-NLR (HR=3.495,95％CI:1.054 ～ 11.589,P ＜ 0.05) and degree of differentiation (HR =3.995,95％ CI:1.050 ～15.198,P＜0.05) were risk factors for OS after liver resection,while preoperative NLR and postoperative NLR alone were not risk factors for overall survival.Multivariate analysis showed that PP-NLR (HR=4.733,95％CI:1.320～16.966,P＜0.05) and degree of differentiation (HR=6.310,95％CI:1.456～27.344,P＜0.05) were independent risk factors for OS after liver resection.Conclusion PP-NLR considers the systemic immune status of preoperative and postoperative,predicts prognosis better than preoperative or postoperative NLR.