Multifactorial Analysis Of Prognostic Factors Of Preoperative Peripheral Blood SIRI,ALRI And NγLR In Patients With Primary Liver Cancer Treated With TACE Combined With Microwave Ablation

Objective:The study was to analyse the factors of preoperative peripheral blood SIRI,ALRI,NγLR for the prognosis of TACE combined with microwave ablation in patients with primary liver cancer,and to provide a reference for the treatment of primary liver cancer.Methods:99 patients diagnosed with primary liver cancer who received TACE combined with microwave ablation for the first time in Affiliated Hospital of You Jiang Medical College for Nationalities from January 1,2016 to December 31,2019 were collected and analyzed retrospectively.The collected data included:(1)gender,age,smoking history,drinking history,hypertension history,ascites,portal vein cancer thrombus;(2)Tumor status:tumor diameter,location,number,and whether cirrhosis is associated;(3)Laboratory examination indicators:AFP value,the latest week before surgery blood biochemical test results(including WBC,Neutrophil,Monocyte,Lymphocyte,Platelets,ALT,AST,GGT,Serum Albumin,Prealbumin),hepatitis B virus infection or not;(4)CT or B-ultrasound guidance,sequential or synchronous treatment,treatment times,postoperative survival time.The optimal critical values of SIRI,ALRI and NγLR were calculated by ROC curve analysis.According to the cut-off values of SIRI,ALRI and NγLR,patients were divided into high SIRI,ALRI,NγLR groups and low SIRI,ALRI,NγLR groups,compare the relationship between these three groups including indicators and clinical features.Use ROC curve analyze the prognostic correlation between the three peripheral blood test indexes in primary liver cancer patients treated by TACE combined with MWA.SPSS 23.0 software was used for statistical analysis,used chi-square(X~2) test to compare count data,kaplan-Meier method was used for single factor analysis survival data,log-rank method was used for test.When P<0.05,the difference was statistically significant.After univariate analysis,significant variables(P<0.05)were incorporated into the Cox multifactor proportional risk model to determine independent predictors of survival.Results:(1)A total number of 99 patients were included in the study,including 91 males and 8 females,median age was 54 years(29-78 years).70 patients’tumors diameter were larger than 5cm,80 patients with single tumors.68 cases of the tumors were located in the right lobe of the liver.There were 32 cases of cirrhosis,81 cases of hepatitis B virus carrier,28 cases of B-ultrasound guide ablation,71 cases of CT-guide ablation,18 cases of sequential treatment,81 cases of synchronous treatment,50 cases of single treatment,49 cases of multiple treatment.The date of surgery was used as the start date and the follow-up period end on June 30,2021.Tumor-related death during the follow-up period was defined as an end event,and patients who were still alive at the end of the follow-up period were treated as truncated data.The unit of survival time was month.At the end of follow-up,36 patients were alive,with overall survival(OS)ranging from 0.2 months to 57.4 months,median survival time was 14.7 months.The one,two,and three-year survival rates were 55.6%,43%,and 41%,respectively.(2)ROC curve results showed that the area under the curve of SIRI was 0.593,corresponding to the best cut-off value was 5.419;The area under the curve of ALRI was0.560,and the corresponding optimal cut-off value was 39.4.The area under the curve of NγLR was 0.642,and the corresponding optimal cut-off value was 765.569.(3)Chi-square test results showed that there were statistically significant differences between different levels of SIRI and preoperative ALB,NγLR,and there were statistically significant differences between different levels of ALRI and preoperative ALB,AST,ALT,GGT,AFP,NγLR.The differences between different levels of NγLR and ALB,AFP,ALRI,SIRI were statistically significant.(4)Kaplan-Meier univariate analysis was performed on patients’general clinical data,SIRI,ALRI and NγLR,and log-rank method was used for test.The results suggested that age,tumor diameter,hepatitis B carrier,portal vein tumor thrombus,preoperative SIRI,ALRI and NγLR were risk factors for death after TACE combined with MWA.The significant variables in univariate analysis were included in COX proportional risk model analysis,and the results suggested that age,tumor diameter,and SIRI were independent risk factors for the prognosis of TACE patients combined with MWA.Conclusion:(1)SIRI,ALRI and NγLR can predict the prognosis of TACE combined with MWA in patients with liver cancer;SIRI>5.419,ALRI>39.4,NγLR>765.569 means poor prognosis;The predictive value of SIRI combined with NγLR is higher than SIRI alone.(2)Age,tumor diameter,hepatitis B,portal vein tumor thrombus,preoperative SIRI,ALRI and NγLR values are risk factors for death after TACE combined with MWA.(3)Age,tumor diameter and SIRI are independent risk factors for prognosis of patients with TACE combined with MWA.