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中华肝脏外科手术学电子杂志 ›› 2021, Vol. 10 ›› Issue (03) : 279 -284. doi: 10.3877/cma.j.issn.2095-3232.2021.03.010

所属专题: 文献

临床研究

APAR对肝细胞癌根治性切除术后患者预后的预测价值
李蒋鹏1, 徐婷2, 杨发才1, 赵芷藜1, 刘小鹏1, 何毅1, 李敬东1,()   
  1. 1. 637000 四川省南充市,川北医学院附属医院肝胆外科 川北医学院肝胆胰肠研究所
    2. 637000 四川省南充市,川北医学院附属医院急诊科
  • 收稿日期:2021-02-18 出版日期:2021-06-10
  • 通信作者: 李敬东
  • 基金资助:
    四川省医学科研青年创新课题计划项目(Q16024); 四川省卫生和计划生育委员会科研课题(18PJ486)

Prognostic value of APAR for patients with hepatocellular carcinoma after radical hepatectomy

Jiangpeng Li1, Ting Xu2, Facai Yang1, Zhili Zhao1, Xiaopeng Liu1, Yi He1, Jingdong Li1,()   

  1. 1. Institute of Hepatobiliary, Pancreatic and Intestinal Surgery, Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
    2. Department of Emergency, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
  • Received:2021-02-18 Published:2021-06-10
  • Corresponding author: Jingdong Li
引用本文:

李蒋鹏, 徐婷, 杨发才, 赵芷藜, 刘小鹏, 何毅, 李敬东. APAR对肝细胞癌根治性切除术后患者预后的预测价值[J/OL]. 中华肝脏外科手术学电子杂志, 2021, 10(03): 279-284.

Jiangpeng Li, Ting Xu, Facai Yang, Zhili Zhao, Xiaopeng Liu, Yi He, Jingdong Li. Prognostic value of APAR for patients with hepatocellular carcinoma after radical hepatectomy[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(03): 279-284.

目的

探讨术前血清ALP和ALB比值(APAR)在肝细胞癌(HCC)根治性切除术后患者预后中的价值。

方法

回顾性分析2015年1月至2019年12月在川北医学院附属医院行根治性切除术的296例HCC患者临床资料。其中男257例,女39例;平均年龄(56±11)岁。患者均签署知情同意书,符合医学伦理学规定。采用ROC曲线确定APAR最佳界值。分析比较高APAR组和低APAR组临床病理学特征;分析APAR与患者术后生存的关系。生存分析采用Kaplan-Meier法和Log-rank检验。采用Cox比例风险回归模型分析HCC根治性切除术后患者预后的影响因素。

结果

根据APAR最佳界值3.38,将患者分为高APAR组(136例)和低APAR组(160例)。高APAR组患者术后1、3、5年无病生存率分别为49.4%、20.0%、5.1%,低APAR组相应为78.6%、42.7%、13.5%,低APAR组无病生存明显优于高APAR组(χ2=44.485,P<0.05)。Cox多因素分析显示,APAR≥3.38 U/g是影响HCC根治性切除术后患者无病生存的独立危险因素(HR=1.788,95%CI:1.241~2.577,P<0.05)。

结论

术前APAR是预测HCC根治性肝切除术后患者预后的独立影响因素,低APAR患者无病生存较佳。

Objective

To evaluate the prognostic value of preoperative serum alkaline phosphatase-to-albumin ratio (APAR) for patients with hepatocellular carcinoma (HCC) after radical hepatectomy.

Methods

Clinical data of 296 HCC patients who underwent radical hepatectomy in the Affiliated Hospital of North Sichuan Medical College from January 2015 to December 2019 were retrospectively analyzed. Among them, 257 patients were male and 39 female, aged (56±11) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. The optimal cut-off value of APAR was determined by the receiver operating characteristic (ROC) curve. The clinicopathological features of the high and low APAR groups were compared and the relationship between APAR and postoperative survival was analyzed. Survival analysis was performed by Kaplan-Meier method and Log-rank test. The prognostic factors of HCC patients after radical resection were identified by Cox's proportional hazards regression model.

Results

All patients were divided into the high APAR group (n=136) and low APAR group (n=160) according to the optimal cut-off value of APAR 3.38. The postoperative 1-, 3- and 5-year disease-free survival in high APAR group were 49.4%, 20.0%, and 5.1%, respectively and were 78.6%, 42.7%, 13.5% in low APAR group, the disease-free survival in low APAR group was significantly better than that in high APAR group (χ2=44.485, P<0.05). Cox's multivariate analysis showed that APAR≥3.38 U/g wasan independent risk factor for the disease-free survival of HCC patients after radical resection (HR=1.788, 95%CI: 1.241-2.577, P<0.05).

Conclusions

Preoperative APAR is an independent prognostic factor for HCC patients after radical hepatectomy. Patients with low APAR have better disease-free survival than those with high APAR.

图1 APAR评估HCC根治性切除术后患者生存情况的ROC曲线
表1 高APAR组和低APAR组HCC根治性切除术患者临床病理特征比较
图2 高、低APAR组HCC根治性切除术后患者无病生存Kaplan-Meier曲线
表2 HCC根治性切除术后患者预后的Cox单因素及多因素分析
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