| Objective: 1.To analyze the factors that affect the prognosis of hepatocellular carcinoma(HCC);2.To explore the prognostic nutritional index(PNI)combined with aspartate transaminase/platelet ratio index(Aspartate transaminase/platelet ratio index),APRI)for the value of patients with hepatocellular carcinoma after hepatectomy;3.Analyze the relevant risk factors that affect the prognosis of patients with hepatocellular carcinoma.Methods: A retrospective analysis of the clinical data of 212 patients with hepatocellular carcinoma who underwent surgical treatment in the Affiliated Hospital of Southwest Medical University from January 1,2014 to December31,2018,was confirmed by histopathology.Measure the patient’s PNI and APRI values one week before surgery,analyze and determine the critical values of PNI and APRI through receiver operating characteristic(ROC)analysis,and conduct single-factor and multi-factor analysis to determine whether the above factors are disease-free The predictive value of survival(Disease-free survival,DFS)and overall survival(OS).Results:(1)Among all cases(212 cases),28 cases(13.2%)survived,and184 cases(86.8%)died.The 1-year,3-year,and 5-year DFS rates of hepatocellular carcinoma patients were 44.3%,13.7%,3.0%,and the 1-year,3-year,and 5-year OS rates were 70.8%,32.5%,and 13.2%.(2)The best cut-off points of preoperative PNI and APRI for judging the overall survival time of hepatocellular carcinoma patients after surgery are 46.13 and 1.75,respectively;(3)Univariate analysis results show: Alpha-fetoprotein(AFP)levels(P=0.039),TNM stage(P=0.035),number of tumors(P=0.003),portal vein tumor thrombus(PVTT)(P=0.032),degree of tumor differentiation(P=0.031),tumor cut Margin(P=0.001),postoperative complications(P=0.045),PNI(P=0.016)and APRI(P<0.001)are important prognostic factors affecting DFS and OS after hepatectomy in patients with hepatocellular carcinoma.Cox is more The result of factor analysis showed that: AFP level(P=0.016),TNM staging(P=0.029),PVTT(P=0.026),PNI(P=0.048)and APRI(P<0.001)are the main factors of postoperative DFS in patients with hepatocellular carcinoma Independent predictors,and TNM stage(P=0.036),PVTT(P=0.017),PNI(P=0.012)and APRI(P<0.001)are independent predictors of postoperative OS in patients with hepatocellular carcinoma.(4)According to the cut-off value of PNI and APRI,it is divided into PNI≤46.13 group(n=45),PNI>46.13 group(n=167),APRI≤1.75 group(n=74)and APRI>1.75 group(n = 138).Survival analysis of patients by the Kaplan-Meier method showed that the 1-year,3-year,and 5-year DFS rates of the PNI>46.13 group were higher than those of the PNI≤46.13 group(47.3%,31.6%,25.0% and 33.3%,respectively,26.7 %,24.0%,P = 0.016).In addition,the 1-year,3-year,and 5-year OS rates of the PNI>46.13 group were higher than those of the PNI≤46.13 group(75.4%,46.8%,42.4% and 53.3%,41.7%,and 20.0%,respectively,P = 0.044).The 1-,3-,and 5-year DFS rates of the APRI≤1.75 group(82.4%,37.7%,and 26.1%,respectively)were significantly higher than those of the APRI>1.75 group(23.9%,18.2%,16.7%,P<0.001).In addition,in the APRI≤1.75 group,the observed 1-year,3-year,and 5-year OS rates were significantly higher than those in the APRI>1.75 group(82.4%,67.2%,46.3% and 64.5%,31.5%,28.6%,respectively,P=0.003).The difference is statistically significant.(5)Set the score of PNI>46.13 or APRI≤1.75 to 0,and set the score of PNI≤46.13 or APRI>1.75 to 1.Groups are as follows: Group 1,PNI≤46.13,APRI≤1.75;Group 2,PNI≤46.13,APRI> 1.75;Group 3,PNI> 46.13,APRI≤1.75;Group4,PNI> 46.13,APRI> 1.75.The results showed that PNI>46.13,APRI≤1.75 group had the highest DFS and OS rate,PNI≤46.13,APRI>1.75 group had the lowest.Conclusion:(1)PNI and APRI are independent influencing factors of DFS and OS after radical hepatectomy in HCC patients.(2)PNI combined with APRI has a good predictive value for patients with hepatocellular carcinoma after surgery.(3)Preoperative PNI≤46.13 and APRI>1.75 suggest that patients with hepatocellular carcinoma have a poor postoperative prognosis. |
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