Prediction Of Prognosis Of Patients With Alpha-fetoprotein Negative Hepatocellular Carcinoma By Preoperative Serum γ-glutaminetransferase Combined With Neutrophil /lymphocyte Ratio

Objective: To explore the predictive value of γ-glutamicalaninetransferase(GGT)and neutrophil / lymphocyte ratio(NLR)system in patients with AFP-negative liver cancer after radical hepatectomy.Methods: A retrospective study was used.The first blood test and other clinicopathological data of 224 patients with AFP-negative hepatocellular carcinoma(AFP≤20 ng/ml)diagnosed in our hospital and underwent radical hepatectomy from January 1,2010 to December 31,2017 were collected.Observation indicators:(1)the optimal cutoff values of GGT and NLR were determined by the receiver operating characteristic curve(ROC).(2)Univariate and multivariate analysis of Clinicopathological data(sex,age,TNM stage(I-II stage/III-IV stage),liver cirrhosis,HBs Ag,NLR,PLT,ALT,AST,ALP,GGT,Child-Pugh grade,differentiation degree,HBV-DNA,MVI,recurrence and early recurrence in AFP negative hepatocellular carcinoma,To explore the risk factors affecting postoperative prognosis of patients.(3)According to the independent risk factors affecting prognosis,the positive outcome score was 1,the negative outcome score was 0,and the system was constructed,analyze the relationship between the system and the overall survival time(OS)and the relapse-free survival(RFS).(4)To further analyze the clinicopathological data of the patients in each group of the corresponding system,to study the relationship between the clinicopathological data and the clinicopathological data,and to use the survival analysis method to analyze the OS of each subgroup,so as to verify the ability of the newly constructed prognostic system to evaluate the prognosis of patients with AFP-negative liver cancer.(5)Finally,the Area under curve(AUC)was used to verify the ability of the newly constructed system to predict 3-and 5-year OS,recurrence and early recurrence in patients.Results:(1)Using ROC curve,the results showed that the optimal cutoff value of GGT was 62.50 U / L,the area under the curve(AUC)was 0.752,the sensitivity was0.750,the sensitivity was 0.697;the optimal cutoff value of NLR was 1.850,the area under the curve was 0.648,the sensitivity was 0.761,and the specificity was 0.576.(2)Univariate analysis showed that HBs Ag,NLR,AST,GGT and MVI were related to prognosis,while multivariate analysis showed that NLR,GGT and MVI were independent prognostic factors.(3)Considering that MVI is the result of postoperative pathology,the purpose of this study is to explore the effect of preoperative markers on the prognosis of hepatocellular carcinoma,so we exclude MVI and construct GGT/NLR system.According to the optimal cutoff value,the score of both increased(GGT > 62.50U/L and NLR > 1.850)was 2,only one of them increased(GGT > 62.50U/L or NLR > 1.850),the score was 1,and the score of patients with no increase in both(GGT ≤ 62.50U/L and NLR ≤ 1.850)was 0.The distribution of patients in each group of GGT/NLR system was as follows: 61 patients with 0 score(27.23%),89 patients with 1 score(39.73%)and 74 patients with 2 score(33.04%).The average survival time was 66.63 ±21.64,59.07 ±24.94,47.64 ±19.25 months respectively(P<0.001).Survival analysis showed that the GGT/NLR system was closely related to the overall survival time of the patients,and the patients with low GGT/NL score had better OS(P<0.001).The total recurrence rates of patients in0,1 and 2 groups were 31.10%,60.70% and 87.80% respectively(P<0.001).Survival analysis showed that patients with low GGT/NLR score had better RFS(P<0.001)(4)Based on the analysis of clinicopathological data of patients with different GGT/NLR scores,it was found that there were significant clinicopathological differences in five clinicopathological data: AST(P<0.001),ALP(P=0.003),Child-Pugh grade(P=0.047),MVI(P<0.001)and early recurrence(P=0.001).The subgroup survival analysis of the above five related factors showed that in the AST normal and elevated subgroup,ALP normal and elevated subgroup,MVI negative and positive subgroup,early and late recurrence subgroup,and Child-Pugh grade A subgroup,the patients with low GGT/NLR score performed better OS than those with high GGT/NLR score(P<0.001),but in the Child-Pugh grade B subgroup,the GGT/NLR system does not show a close relationship with the patient’s OS(P=0.447).(5)Using the Area under curve(AUC)to evaluate the ability of GGT/NLR system to predict the prognosis of AFP-negative liver cancer.it was found that the predictive value of GGT/NLR for5-year survival of patients with AFP-negative liver cancer was 0.716(95% CI:0.635-0.798,P<0.001).The predictive value of GGT/NLR for 3-year survival of patients with AFP-negative liver cancer after radical hepatectomy was 0.707(95%CI:0.610-0.804,P<0.001).The predictive value of GGT/NLR for postoperative recurrence in patients with AFP-negative liver cancer was 0.751(95%CI:0.686-0.816,P<0.001),and the predictive value of GGT/NLR for early postoperative recurrence in patients with AFP-negative liver cancer was 0.641(95%CI:0.568-0.714,P<0.001).Conclusion: Preoperative serum GGT and NLR are independent risk factors for prognosis after radical hepatectomy in patients with AFP negative hepatectomy.GGT/NLR system is significantly correlated with preoperative liver function damage(ALP,AST)and MVI in patients with AFP negative liver cancer,and has good predictive ability for postoperative survival and recurrence in patients with AFP negative liver cancer.