| Objective: To investigate the correlation between preoperative nutritional risk status and immune function and clinical outcome in patients with hepatocellular carcinoma.Methods:The clinical data of 206 patients with hepatocellular carcinoma(HCC)who underwent surgical treatment in the Cancer Hospital Affiliated to Guangxi Medical University from March 1,2015 to April 30,2020 were retrospectively analyzed,They were divided into nutritional risk group and non nutritional risk group.The clinical data of the two groups were compared and analyzed.The measurement data were analyzed by independent sample t-test,the counting data were analyzed by chi square test,and the independent influencing factors of postoperative liver dysfunction were analyzed by binary logistic regression.Kaplan Meier method was used to analyze the 1-,3-,5-year recurrence rate and survival rate of the two groups.Cox regression model was used to analyze the risk factors of recurrence and death in patients with liver cancer.Results:1.Among 206 patients,there were 73 patients with nutritional risk,accounting for 35.4% of the total number of patients;There were 133 patients in the non nutritional risk group,accounting for 64.6% of the total cases.2.In the nutritional risk group,the preoperative IgG level was(13.68±4.41)、IgM(1.31±1.79)、IgA(2.80±1.11)、c3(0.95±0.28)、c4(0.25±0.11)and IgG(11.69±4.79)、IgM(1.03±0.58)、IgA(2.41±0.98)、c3(0.70±0.22)、c4(0.17±0.08)The differences were statistically significant(P < 0.05).In the non nutritional risk group,the preoperative IgG level was(12.98±3.46)、IgM(1.59±1.35)、IgA(3.10±1.26)、c3(1.00±0.24)、c4(0.26±0.11)and IgG(11.71±4.07)、IgM(1.35±1.38)、IgA(2.63±1.34)、c3(0.78±0.22)、c4(0.19±0.09)respectively,the differences were statistically significant(P <0.05).There was no significant difference in preoperative IgG,IgM,IgA,C3 and C4 between the two groups(P > 0.05);After operation,the IgM level of the nutritional risk group was(1.03±0.58),IgA level(2.41±0.98)was significantly higher than that in the non nutritional risk group(1.35± 1.38)、IgA(2.63±1.34)respectively,the differences were statistically significant(P < 0.05).The preoperative total T lymphocytes of patients with nutritional risk group were(66.11±7.89),helper lymphocyte(39.80±8.93),inhibitory lymphocyte(20.82±7.35)and total T lymphocytes(60.87±11.36),helper lymphocyte(36.04±8.48),inhibitory lymphocyte(18.25±5.68)respectively,the differences were statistically significant(P < 0.05).In the non nutritional risk group,the preoperative total T lymphocyte count was(66.40±9.50),helper lymphocyte(38.47±6.77),inhibitory lymphocyte(21.59±7.36)and total T lymphocytes(63.37±8.62),helper lymphocyte(35.81±7.86),inhibitory lymphocyte(20.79±8.22)respectively,the differences were statistically significant(P < 0.05);Before operation,the total T lymphocytes of nutritional risk group were(66.11±7.89)、TH/TS(2.36±1.35)was significantly higher than that in the non nutritional risk group(66.40±9.50)、TH/TS(1.90±0.80)respectively,and the differences were statistically significant(P < 0.05).After operation,the total T lymphocytes in the nutritional risk group were(60.87±11.36)、 TH/TS(2.11±6.59)was significantly higher than that in the non nutritional risk group(63.37±8.62)、 TH/TS(1.87±0.82)respectively,and the differences were statistically significant(P < 0.05).3.The incidence of postoperative liver dysfunction was 35.6% in patients with nutritional risk and 21.1% in patients without nutritional risk(x~2= 5.168,P= 0.023).Binary logistic regression analysis showed that nutritional risk,ICG-R15 suggesting poor liver function reserve and large amount of intraoperative blood loss were independent risk factors for postoperative liver dysfunction(P < 0.05).4.The 1-,3-,and 5-year recurrence rates in the nutritional risk group were57.5%,72.6%,and 74.0%,respectively.The median disease-free survival time was 10 months;The 1-,3-,and 5-year recurrence rates were 36.1%,56.4% and59.4% respectively in the non nutritional risk group,and the median disease-free survival time was 21.6 months.There was significant difference in the 1-,3-,5-year recurrence risk curve between the two groups(x~2=7.040,P=0.008;x~2=6.120,P=0.013;x~2=5.532,P=0.019)。Multivariate Cox regression analysis showed that nutritional risk(HR = 1.586,95% CI: 1.12-2.245,P =0.009)and high preoperative AFP level(HR = 1.638,95% CI: 1.163-2.307,P =0.005)were risk factors for recurrence of HCC.5.The 1-,3-and 5-year survival rates were 76.4%,53.1% and 31.9% in the nutritional risk group,and the median survival time was 25.6 months;The 1-,3-,and 5-year survival rates were 87.9%,75.9%,and 44.9% in the non nutritional risk group,and the median survival time was 41.3 months;There were significant differences in 1-,3-,5-year survival curves between the two groups(x~2= 4.518,P = 0.034;x~2=8.700,P=0.003;x~2=5.810,P=0.016)。Multivariate Cox proportional hazards regression analysis showed that nutritional risk(HR = 1.650,95% CI: 1.095-2.486,P = 0.017)and intraoperative blood loss(HR = 1.965,95% CI: 1.169-3.304,P = 0.011)were the risk factors for the death of HCC patients.Conclusion: 1.In HCC patients undergoing hepatectomy,compared with the non nutritional risk group,the nutritional risk group has poor immune function.2.Compared with the non nutritional risk group,the nutritional risk group was more prone to liver dysfunction,higher recurrence rate and lower survival rate.3.There is a certain correlation between preoperative nutritional risk status and immune function and clinical outcome in patients with liver cancer. |
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