Comparion Of Prognostic Value Of NLR?PLR?GGT And ALBI In Patients With Hepatocellular Carcinoma

Background and Objective:How to evaluate patients in clinical treatment of survival to formulate the reasonable treatment of hepatocellular carcinoma?HCC?and improve the quality of patients with liver cancer survival are of great importance.Have a close relationship between inflammation and cancer,epidemiological studies have shown that 15%to 20%of human tumors are caused by infection and inflammation.At present,there are few studies on the prognosis of patients with HCC with neutrophil to lymphocyte ratio?NLR?and platelet to lymphocyte ratio?PLR?.glutamyl transpeptidase?GGT?abnormal expression in the liver closely related to the occurrence and progress of HCC and has become one of HCC early diagnosis index.Child-Turcotte-Pugh?CPT?score liver function classification includes serum albumin,bilirubin,and prothrombin time,but also including hepatic encephalopathy and the existence of ascites.Therefore,according to CTP liver function classification results have certain subjectivity.So the CTP liver function classification is applied to the evaluation of HCC patients with liver function has been controversial.In 2015,Philip et al.The clinical survival data of 1313 cases of Japanese patients with HCC were analyzed,and the application of COX risk scale model statistics analysis found that log₁₀?Bilirubin?and albumin are independent prognostic factors in patients with HCC.A simple evaluation model based on log₁₀?Bilirubin?and ALB was obtained:ALBI=0.66×log₁₀?Bilirubin?-0.085×ALB.According to the ALBI grading standard,The cut points were as follows:ALBI?-2.60?ALBI grade 1?,more than-2.60 to?-1.39?ALBI grade 2?,and ALBI more than-1.39?ALBI grade 3?.The purpose of this paper is to evaluate and compare the value of NLR,PLR,GGT and ALBI on prognosis of HCC patients,and to better guide clinical treatment and prognosis.Methods:Retrospective analysis was performed on 504 cases of hepatocellular carcinoma treated by the Guangxi medical university affiliated tumor hospital from January 2008 to December 2014.All patients were followed up until November 1.2017.Collecting general information and clinical data of patients,The survival data were analyzed by kaplan-meier method for single factor analysis,and the statistical significance of single factor?P<0.05?was included in COX regression for multivariate analysis,and the prognostic factors with statistical significance were calculated by P<0.05.For the four indexes of NLR?PLR?GGT and ALBI,the kaplan-meier method was used for survival analysis,and the log-rank method was used to test,and P<0.05 was set to be statistically significant.After univariate analysis,only P value<0.05 was used in the multivariate analysis,and Cox proportional risk model was used to determine independent survival predictors.The likelihood ratio?²?LR?²?and linear trend?² test were calculated to evaluate homogeneity and heterogeneity of different indexes respectively.Using Akaike information criterion?AIC?and C_P statistic?Mallows?to evaluate model fit and prediction ability respectively.The prognostic efficacy of each indicator in predicting the prognosis ofHCC patients was evaluated.Results:Follow-up until November 1,2017,A total of 375 patients died,accounting for 74.4%.The minimum survival time is 25 days,the longest is 3450days,and the median survival time is 630 days.The 1-year,3-year and 5-year survival rates were 60.5%,37.1%and 21.8%respectively.According to COX regression multivariate analysis,albumin,AST,AFP,tumor number,tumor maximum diameter,vascular invasion,ascites were independent factors affecting the prognosis of patients with hepatocellular carcinoma.According to the ROC curve,NLR=2.42,PLR=114.57,GGT=71.5 is the critical value.According to the ALBI grading standard,The cut points were as follows:ALBI?-2.60?ALBI grade 1?,more than-2.60 to?-1.39?ALBI grade 2?,and ALBI more than-1.39?ALBI grade 3?.The survival curve was plotted by kaplan-meier method,and the log-rank test comparison results showed that the survival rate of patients with NLR<2.42 group was significantly higher than that in NLR?2.42 group?P<0.0001?.The survival rate of patients with PLR<114.57was significantly higher than that in PLR?114.57 group?P<0.0001?.The survival rate of GGT<71.5 group was significantly higher than that in GGT?71.5 group?P<0.0001?.ALBI 1 HCC patients with the best prognosis,ALBI 2 is second,and ALBI 3 is the worst.After univariate analysis,NLR,PLR,GGT and ALBI were included in the Cox proportional risk model,indicating that NLR,GGT,and ALBI were independent factors influencing the survival of HCC patients.PLR did not enter the model?P>0.05?.Compared with NLR,GGT and ALBI,the prognostic ability of HCC patients was predicted,and the ALBI classification showed the best prognosis.Considering the treatment affect the prognosis,this research continues to detect ALBI prognostic value in patients with different treatment group,found that in addition to the pure radiofrequency ablation group ALBI 1 level and ALBI 2 level in patients with HCC As well as surgical and TACE and sorafenib group ALBI 2 liver cancer patients and ALBI3 patients with HCC,The survival rate was not statistically significant,The rest of the patients showed the best prognosis for patients with ALBI level 1,second in ALBI 2,and worst in ALBI 3.Conclusions:Albumin,AST,AFP,tumor number,tumor maximum diameter,vascular invasion,ascites were independent factors affecting the prognosis of patients with hepatocellular carcinoma.The survival rate of patients with low NLR group was higher than that in high NLR group.The survival rate of patients with low PLR group was higher than that of high PLR group.The survival rate of patients with low GGT group was higher than that in the high GGT group.ALBI 1 patients with HCC had the best prognosis,with ALBI 2patients being second and ALBI 3 patients were the worst.NLR,PLR,GGT and ALBI were included in the Cox proportional risk model,indicating that NLR,GGT and ALBI were independent influences of survival of HCC patients,and PLR did not enter the model?P>0.05?.Compared with NLR,GGT and ALBI,the prognostic ability of patients with HCC was predicted,and the ALBI classification showed the best prognosis.