探讨术后预后营养指数（post-PNI）在肝细胞癌（肝癌）肝切除患者预后中的价值。

回顾性分析2009年1月至2014年12月在中山大学附属第三医院行肝癌肝切除的316例患者临床资料。其中男289例，女27例；平均年龄（50±12）岁。患者均签署知情同意书，符合医学伦理学规定。采用患者术后第一次检查的ALB及淋巴细胞计数计算post-PNI。根据受试者工作特征（ROC）曲线确定post-PNI的最佳截断值，将患者分为高post-PNI组及低post-PNI组。两组生存分析采用Kaplan-Meier法和Log-rank检验，Cox比例风险模型评估生存预后的因素影响。

ROC曲线决定post-PNI最佳截断值为36.4。高post-PNI组165例，低post-PNI组151例。高post-PNI组1、3、5年无复发生存率和总体生存率分别为74.4%、55.5%、50.3%和93.8%、85.9%、78.7%，低post-PNI组相应为60.9%、32.5%、27.1%和91.3%、72.0%、62.9%，差异有统计学意义（χ²=16.939，8.428；P<0.05）。多因素分析显示post-PNI≤36.4是肝癌肝切除患者无复发生存和总体生存的独立危险因素（HR=1.705，1.771；P<0.05）。

post-PNI是肝癌肝切除患者无复发生存和总体生存的独立影响因素，低post-PNI患者预后差。

To explore the value of postoperative prognostic nutritional index (post-PNI) in the prognosis of patients with hepatocellular carcinoma (HCC) after hepatectomy.

Clinical data of 316 patients receiving HCC hepatectomy in the Third Affiliated Hospital of Sun Yat-sen University between January 2009 and December 2014 was analyzed retrospectively. There were 289 males and 27 females, with a mean age of (50±12) years. The informed consents of all patients were obtained and the local ethical committee approval was received. Post-PNI was calculated using value of ALB and lymphocyte count of the first examination after operation. The optimum cut-off value of post-PNI was defined according to receivers' operating characteristic (ROC) curve, and the patients were divided into high post-PNI group and low post-PNI group. Survival analysis of two groups was conducted using Kaplan-Meier method and Log-rank test, and the influencing factors for survival and prognosis were analyzed by Cox proportional hazard model.

The optimum cut-off value of post-PNI was 36.4 by ROC curve. There were 165 cases in high post-PNI group, and 151 cases in low post-PNI group. The 1-, 3- and 5-year recurrence-free survival rate and overall survival rate of the high post-PNI group were respectively 74.4%, 55.5%, 50.3% and 93.8%, 85.9%, 78.7%, and were respectively 60.9%, 32.5%, 27.1% and 91.3%, 72.0% and 62.9% in low post-PNI group were, where significant differences were observed (χ²=16.939, 8.428; P<0.05). Multiple-factor analysis showed that post-PNI≤36.4 was the independent risk factor for the recurrence-free survival and overall survival of HCC hepatectomy patients (HR=1.705, 1.771; P<0.05).

Post-PNI is an influencing factor for the recurrence-free survival and overall survival of HCC hepatectomy patients. Low post-PNI patients have worse prognosis.