APAR对肝细胞癌根治性切除术后患者预后的预测价值

doi:10.3877/cma.j.issn.2095-3232.2021.03.010

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。

关键词: 碱性磷酸酶, 白蛋白, 癌, 肝细胞, 肝切除术, 预后

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.

Key words: Alkaline phosphatase, Albumin, Carcinoma, hepatocellular, Hepatectomy, Prognosis

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

临床特征	例数	GGT[U/L，M（Q_R）]	ALT[U/L，M（Q_R）]	AST[U/L，M（Q_R）]	TB[μmol/L，M（Q_R）]	最大肿瘤直径[cm，M（Q_R）]
高APAR组	136	95（156）	60（74）	58（71）	18（10）	7.0（6）
低APAR组	160	63（105）	50（46）	50（53）	16（10）	4.5（3）
统计值		Z=2.998	Z=2.307	Z=2.338	Z=0.770	Z=4.789
P值		<0.05	<0.05	<0.05	0.441	<0.05
临床特征	例数	肝硬化（例）		大血管侵犯（例）		BCLC分期（例）		肿瘤复发（例）
临床特征	例数	有	无	有	无	0+A期	B期	有	无
高APAR组	136	109	27	81	55	78	58	96	40
低APAR组	160	99	61	36	124	124	36	61	99
统计值		χ²=11.748		χ²=42.237		χ²=13.769		χ²=31.104
P值		<0.05		<0.05		<0.05		<0.05

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

临床特征	例数	GGT[U/L，M（Q_R）]	ALT[U/L，M（Q_R）]	AST[U/L，M（Q_R）]	TB[μmol/L，M（Q_R）]	最大肿瘤直径[cm，M（Q_R）]
高APAR组	136	95（156）	60（74）	58（71）	18（10）	7.0（6）
低APAR组	160	63（105）	50（46）	50（53）	16（10）	4.5（3）
统计值		Z=2.998	Z=2.307	Z=2.338	Z=0.770	Z=4.789
P值		<0.05	<0.05	<0.05	0.441	<0.05
临床特征	例数	肝硬化（例）		大血管侵犯（例）		BCLC分期（例）		肿瘤复发（例）
临床特征	例数	有	无	有	无	0+A期	B期	有	无
高APAR组	136	109	27	81	55	78	58	96	40
低APAR组	160	99	61	36	124	124	36	61	99
统计值		χ²=11.748		χ²=42.237		χ²=13.769		χ²=31.104
P值		<0.05		<0.05		<0.05		<0.05

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

临床特征	单因素分析		多因素分析
	HR（95%CI）	P值	HR（95%CI）	P值
肿瘤最大直径>7 cm	1.201（1.150～1.255）	<0.05	1.104（1.045～1.167）	<0.05
肿瘤数量≥3个	1.443（1.031～2.021）	<0.05	1.446（1.029～2.034）	<0.05
肝硬化	1.934（1.299～2.879）	<0.05	1.672（1.110～2.518）	<0.05
大血管侵犯	1.637（1.195～2.242）	<0.05	1.035（0.735～1.458）	0.844
BCLC-B期	0.289（0.210～0.397）	<0.05	0.454（0.312～0.660）	<0.05
APAR≥3.38 U/g	2.655（1.924～3.665）	<0.05	1.788（1.241～2.577）	<0.05

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

临床特征	单因素分析		多因素分析
	HR（95%CI）	P值	HR（95%CI）	P值
肿瘤最大直径>7 cm	1.201（1.150～1.255）	<0.05	1.104（1.045～1.167）	<0.05
肿瘤数量≥3个	1.443（1.031～2.021）	<0.05	1.446（1.029～2.034）	<0.05
肝硬化	1.934（1.299～2.879）	<0.05	1.672（1.110～2.518）	<0.05
大血管侵犯	1.637（1.195～2.242）	<0.05	1.035（0.735～1.458）	0.844
BCLC-B期	0.289（0.210～0.397）	<0.05	0.454（0.312～0.660）	<0.05
APAR≥3.38 U/g	2.655（1.924～3.665）	<0.05	1.788（1.241～2.577）	<0.05

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

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