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中华肝脏外科手术学电子杂志 ›› 2026, Vol. 15 ›› Issue (03) : 372 -378. doi: 10.3877/cma.j.issn.2095-3232.2026.03.011

临床研究

小野寺预后营养指数对肝癌复发预测价值
叶金宝1, 梁声强1, 马建新1, 林小强1, 张海森2,†()   
  1. 1　363000　福建省漳州市，第九〇九医院（厦门大学附属东南医院）检验科
    2　363000　福建省漳州市，第九〇九医院（厦门大学附属东南医院）普通外科
  • 收稿日期:2025-11-01 出版日期:2026-06-10
  • 通信作者: 张海森
  • 基金资助:
    福建省自然科学基金(2023J011841)

Predictive value of Onodera's prognostic nutritional index for recurrence of hepatocellular carcinoma

Jinbao Ye1, Shengqiang Liang1, Jianxin Ma1, Xiaoqiang Lin1, Haisen Zhang2,†()   

  1. 1 Clinical Laboratory, the 909th Hospital (Southeast Hospital Affiliated to Xiamen University), Zhangzhou 363000, China
    2 Department of General Surgery, the 909th Hospital (Southeast Hospital Affiliated to Xiamen University), Zhangzhou 363000, China
  • Received:2025-11-01 Published:2026-06-10
  • Corresponding author: Haisen Zhang
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引用本文：

叶金宝, 梁声强, 马建新, 林小强, 张海森. 小野寺预后营养指数对肝癌复发预测价值[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(03): 372-378.

Jinbao Ye, Shengqiang Liang, Jianxin Ma, Xiaoqiang Lin, Haisen Zhang. Predictive value of Onodera's prognostic nutritional index for recurrence of hepatocellular carcinoma[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2026, 15(03): 372-378.

目的

探讨小野寺预后营养指数（OPNI）与肝细胞癌（肝癌）临床病理特征关系及其对术后肿瘤复发影响。

方法

回顾性分析2018年1月至2021年12月厦门大学附属东南医院收治的147例肝癌患者临床病理资料。患者均签署知情同意书，符合医学伦理学规定。其中男94例，女43例；年龄（63±7）岁。所有患者均接受根治性手术切除，术后随访3年或肿瘤复发。OPNI与患者临床病理特征相关性分析采用t检验，绘制ROC曲线分析OPNI对肝癌术后复发的预测价值，确定最佳预测界值。Cox单因素和多因素分析肝癌术后复发独立危险因素。累积复发率分析采用Kaplan-Meier法和Log-rank检验。

结果

总体患者OPNI为45.3±4.0。AFP≥400 μg/L、肿瘤直径≥5 cm、肿瘤低分化、肿瘤包膜不完整、微血管侵犯（MVI）、CNLC分期Ⅱ期、术后复发与患者OPNI降低有关（t=3.114，2.836，-3.009，2.116，3.946，3.273，-7.000； P<0.05）。ROC曲线分析发现OPNI对肝癌术后复发有预测价值，最佳预测界值为43.5，AUC为0.785，95%CI为0.708~0.862，灵敏度为0.875，特异度为0.682。Cox单因素分析发现女性、AFP≥400 μg/L、肿瘤直径≥5 cm、肿瘤包膜不完整、MVI、CNLC分期Ⅱ期、术后无介入治疗、OPNI<43.5与患者高复发率相关。Cox多因素分析发现肿瘤直径≥5 cm（HR=3.464，95%CI：1.376~8.716）、术后无介入治疗（HR=7.300，95%CI：2.415~22.070）、OPNI<43.5（HR=16.208，95%CI：5.586~47.022）是肝癌术后复发独立危险因素。OPNI<43.5患者3年累积复发率为81.81%，OPNI≥43.5患者3年复发率为23.91%，差异有统计学意义（χ2= 17.177，P<0.001）。

结论

术前OPNI降低与肝癌患者不良临床病理学特征相关，OPNI<43.5是肝癌术后复发独立危险因素。

关键词: 小野寺预后营养指数, 癌，肝细胞, 根治性切除术, 肿瘤复发, 临床特征, 病理特征
Objective

To investigate the correlation between Onodera's Prognostic Nutritional Index (OPNI) and clinicopathological features of hepatocellular carcinoma (HCC) and assess the effect on postoperative tumor recurrence.

Methods

Clinicopathological data of 147 patients with HCC admitted to Southeast Hospital affiliated to Xiamen University from January 2018 to December 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 94 patients were male and 43 female, aged (63±7) years on average. All patients underwent radical surgical resection and were followed up for 3 years or tumor recurrence. The correlation between OPNI and clinicopathological features of HCC patients was carried out by t-test.The receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of OPNI for postoperative recurrence of HCC, and the optimal threshold value was determined. The independent risk factors for postoperative recurrence of HCC were identified by univariate and multivariate Cox analyses. The cumulative recurrence rate was analyzed by Kaplan-Meier method and Log-rank test.

Results

The OPNI of all patients was 45.3±4.0. AFP≥400 μg/L, tumor diameter≥5 cm, poorly differentiated tumor, incomplete tumor capsule, microvascular invasion (MVI), CNLC stage Ⅱ and postoperative recurrence were correlated with the decrease of OPNI (t=3.114, 2.836,-3.009, 2.116, 3.946, 3.273,-7.000. all P<0.05). ROC curve showed that OPNI had predictive value for postoperative recurrence of HCC. The optimal threshold value was 43.5.The area under the ROC curve (AUC) of OPNI was 0.785 (95%CI: 0.708-0.862), the sensitivity was 0.875 and the specificity was 0.682, respectively. Univariate Cox analysis showed that female gender, AFP≥400 μg/L, tumor diameter≥5 cm, incomplete tumor capsule, MVI, CNLC stage Ⅱ, no postoperative interventional therapy and OPNI<43.5 were correlated with high recurrence rate of HCC patients. Multivariate Cox analysis revealed that tumor diameter ≥5 cm (HR=3.464, 95%CI: 1.376-8.716), no postoperative interventional therapy (HR=7.300, 95%CI: 2.415-22.070) and OPNI<43.5 (HR=16.208, 95%CI: 5.586-47.022) were the independent risk factors for postoperative recurrence of HCC. The 3-year cumulative recurrence rate of patients with OPNI<43.5 was 81.81%, and 23.91% for those with OPNI≥43.5, and the difference was statistically significant (χ2=17.177, P<0.001).

Conclusions

Preoperative decrease of OPNI is correlated with poor clinicopathological features in HCC patients. OPNI<43.5 is an independent risk factor for postoperative recurrence of HCC.

Key words: Onodera's prognostic nutritional index, Carcinoma,hepatocellular, Radical resection, Tumor recurrence, Clinical characteristics, Pathological features
表1 OPNI与肝癌临床病理特征相关性分析（
±s）
临床资料 例数 OPNI t值 P值
年龄(岁) -0.093 0.926
<60 32 45.3±3.7
≥60 115 45.3±4.1
性别 1.257 0.211
男 94 45.6±3.8
女 53 44.7±4.3
HBV感染 -0.171 0.864
阳性 67 45.2±4.0
阴性 80 45.3±4.0
饮酒史 0.495 0.621
有 51 45.5±3.8
无 96 45.2±4.1
Child-Pugh分级 0.178 0.859
A级 94 45.3±4.0
B级 53 45.2±4.0
AFP(μg/L) 3.114 0.002
<400 54 46.6±4.1
≥400 93 44.5±3.7
手术方式 -0.366 0.738
开腹 74 45.2±3.9
腹腔镜 73 45.4±4.1
肿瘤部位 1.346* 0.197
左肝 70 45.2±3.8
右肝 57 44.8±4.2
中肝 20 45.3±4.8
肿瘤直径(cm) 2.836 0.005
<5 82 46.1±3.8
≥5 65 44.3±4.0
分化程度 -3.009 0.003
低分化 64 44.2±3.5
中高分化 83 46.1±4.1
肿瘤包膜 2.116 0.032
完整 112 45.7±3.8
不完整 35 44.0±4.4
MVI 3.946 <0.001
无 115 45.9±3.8
有 32 42.9±4.0
肝切除方式 0.382 0.703
解剖性切除 91 45.4±3.9
非解剖性切除 56 45.1±4.1
CNLC分期 3.273 0.001
Ⅰ期 110 45.9±3.7
Ⅱ期 37 43.5±4.3
术后介入治疗 -0.142 0.887
有 53 45.2±4.0
无 94 45.3±4.0
术后复发 -7.000 0.011
是 67 43.1±4.0
否 80 47.2±3.0
图1 OPNI预测肝癌术后复发ROC曲线分析 注：OPNI为小野寺预后营养指数，MVI为微血管侵犯
表2 肝癌患者术后复发影响Cox单因素分析
因素 b SE(b) Waldχ2 HR 95%CI P值
年龄≥60岁 0.521 0.399 1.709 1.685 0.771~3.682 0.191
女性 1.009 0.338 8.935 2.743 1.415~5.315 0.003
HBV感染 0.250 0.392 0.407 1.284 0.595~2.771 0.524
饮酒史 0.113 0.304 0.139 1.120 0.618~2.031 0.709
Child-Pugh分级B级 0.363 0.299 1.469 1.437 0.800~2.582 0.225
AFP≥400 μg/L 0.416 0.202 4.229 1.515 1.020~2.252 0.040
腹腔镜手术 -0.127 0.316 0.162 0.880 0.474~1.636 0.687
肿瘤部位(中肝)
左肝 -0.267 0.358 0.556 0.766 0.380~1.544 0.456
右肝 -0.518 0.343 2.282 0.596 0.304~1.166 0.131
肿瘤直径≥5 cm 1.280 0.689 3.453 3.599 1.734~7.908 <0.001
肿瘤低分化 0.807 0.581 1.931 2.243 0.846~5.079 0.136
肿瘤包膜不完整 0.642 0.463 1.994 1.992 1.315~11.984 0.031
MVI 0.973 0.607 2.570 2.647 1.730~9.364 0.011
解剖性肝切除 -0.504 0.344 2.146 0.604 0.308~1.185 0.604
CNLC分期Ⅱ期 0.879 0.551 2.546 2.409 1.344~13.549 <0.001
术后无介入治疗 1.094 0.537 4.152 2.988 1.469~11.372 <0.001
OPNI<43.5 1.329 0.637 4.354 3.778 1.129~6.543 <0.001
表3 肝癌术后复发Cox多因素分析
因素 b SE(b) Waldχ2 HR 95%CI P值
女性 -0.044 0.481 0.008 0.957 0.373~2.455 0.927
AFP≥400 μg/L 0.855 0.498 2.952 2.352 0.887~6.240 0.086
肿瘤直径≥5 cm 1.242 0.471 6.692 3.464 1.376~8.716 0.008
肿瘤包膜不完整 0.080 0.608 0.017 1.084 0.329~3.566 0.895
MVI 0.212 0.642 0.109 1.236 0.351~4.345 0.742
CNLC分期Ⅱ期 0.242 0.578 0.175 1.274 0.410~3.955 0.676
术后无介入治疗 1.988 0.564 12.404 7.300 2.415~22.070 <0.001
OPNI<43.5 2.785 0.543 26.271 16.208 5.586~47.022 <0.001
图2 不同OPNI患者复发生存曲线分析
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