| Objective:By measuring the preoperative and postoperative neutrophil×monocyte/lymphocyte ratio(SIRI)level,aspartate aminotransferase platelet ratio index(APRI)level,and observing the relationship between the two indicators and clinical characteristics.We investigate the clinical significance of SIRI and APRI level in predicting the overall survival rate of patients with hepatitis B-related hepatocellular carcinoma after Transarterial chemoembolizationMethods:A total of 109 patients with complete case data were collected from January 2016 to December 2018 in the digestive and interventional department in the Northern Jiangsu People’s Hospital.These patients were all diagnosed as hepatitis B-related primary liver cancer,and successfully performed TACE for the first time,which met the inclusion and exclusion criteria.109 patients were tested for infectious markers and HBV DNA.The routine blood test,liver function test.Child-Pugh classification,BCLC stage and imaging data were recorded.All the above indexes were evaluated within one week before TACE operation,and the routine blood test and liver function test were collected within one week and one month after operation.The survival time of patients was followed up by telephone.The follow-up time was 25.16±11.86 months(1～46 months).SIRI and APRI were calculated according to formula:SIRI=number of monocytes × number of neutrophils/number of lymphocytes;APRI=(aspartate aminotransferase value/ULN)/platelet count/100,where ULN is the upper limit of normal reference value 40 U/L in this hospital.Spss 24.0 was used for statistical analysis.SIRI and APRI were classified by the cut-off values,which were determined by the receiver operating characteristic curve.Other variables were converted into dichotomous data with clinical significance.The univariate and multivariate analysis were carried out to obtain the predictive value of each index for postoperative survival of patientsResults:1.Among the selected patients,74 cases were HBeAg negative and 35 cases were HBeAg positive;HBV-DNA<103 copies/ml was defined as HBV-DNA negative,HBV-DNA≥103copies/ml was defined as HBV-DNA positive.There were 47 patients with HBV-DNA negative.and 62 patients with HBV-DNA positive.47 cases were HBV-DNA<103 copies/ml,36 cases were HBV-DNA 103～105 copies/ml,26 cases were HBV-DNA≥05copies/ml;79 patients received preoperative antiviral therapy.and 30 cases did not receive antiviral therapy.There were 78 patients with liver function Child-Pugh A grade and 31 patients with Child-Pugh B.There were 37 patients without cirrhosis,and 72 with cirrhosis background.Tumor diameter ≤5 cm in 48 patients,5～10cm in 41 patients and>10cm in 20 patients.There were 80 patients without portal vein tumor thrombus and 29 patients with portal vein tumor thrombus2.Overall survival:a total of 109 patients were selected,with a median survival of 25 months.the cumulative survival rates were 97.2%.84.4%,54.1%,21.1%for half a year,one year,two years and three years after TACE3.Univariate and multivariate analysis for patients with HCC after TACE:Univariate analysis showed that SIRI(P=0,013),APRI(P=0.000),HBV-DNA level(P=0.007)HBeAg status(P=0.008).preoperative antiviral treatment(P=0.007),liver function Child-Pugh grade(P=0.001),BCLC stage(P=0.001),tumor diameter(P=0,008),portal vein tumor thrombus(P=0.029),preoperative cirrhosis background(P=0.003)were all correlated with prognosis after TACE.By COX multivariate regression analysis,HBeAg status,liver function Child-Pugh grade,cirrhosis background,portal vein tumor thrombus were independent factors affecting the prognosis of TACE.4.SIRI,APRI can predict the prognosis of patients underwent TACE.The area under the ROC curve was 0.701(P=0.003)and 0.735(P=0.01).The 95%confidence intervals were 0.593～0.809 and 0.630～0.841 respectively.The yodden index was 0.361 and 0.41 respectively.The corresponding cut-off values were 1.03 and 1.33.The sensitivity was 0.709 and 0.453,and the specificity was 0.652 and 0.9575,Preoperative SIRI,APRI level survival analysis showed that the half-year,one-year,two-year and three-year survival rates of patients with low SIRI,low APRI groups were higher than those of high SIRI and high APRI groups.The half-year,one-year,two-year and three-year survival rate of patients with SIRI elevated within one week after TACE were higher than those of the group without elevated.The half-year,one-year,two-year and three-year survival rate of patients with APRI elevation one week after TACE had no significant difference with the group without elevation(P=0.773).When the radio SIRI<1.03 and APRI<1.33,patients showed the best prognosis.When the radio SIRI≥1.03 and APRI≥1.33,patients showed the worst prognosis.6.The SIRI value one week after TACE was higher than that before TACE(P=0.000).The SIRI value one month after TACE was not significantly different from that in preoperative SIRI(P=0.774).The APRI value one week after TACE was higher than that before TACE(0.000),and there was no significant difference between the APRI value one month after TACE and preoperative APRI(P=0.924).7.The relationship between clinical features and survival after TACE:HBV-DNA positive,HBeAg positive,preoperative non-antiviral therapy,liver function Child-Pugh B grade.BCLC B-C stage,tumor diameter>10 cm,patients with portal vein tumor thrombus and preoperative cirrhosis background had shorter postoperative survival.The prognosis after antiviral therapy was better than that of the non-antiviral treatment group,whether HBV-DNA、HBeAg positive or negative(P<0.05).8.Relationship between SIRI,APRI and clinical features of hepatitis B-related liver cancer patients:When SIRI<1.03,patients have characteristics of HBeAg negative,HBV-DNA level<103 copies/ml,liver function Child-Pugh A grade,BCLC 0-A stage,without liver cirrhosis,tumor diameter≤5cm,preoperative antiviral treatment.When SIRI≥1.03,patients have characteristics of HBeAg positive,HBV-DNA level≥105 copies/ml,liver function Child-Pugh B grade,BCLC B-C stage,with liver cirrhosis,tumor diameter≥10cm,without preoperative antiviral treatment.When APRI<1.33,patients have characteristics of HBeAg negative,HBV-DNA level<103copies/ml,liver function Child-Pugh A grade,BCLC 0-A stage,without liver cirrhosis,without portal vein tumor thrombus,tumor diameter≤5cm,with preoperative antiviral treatment.When APRI≥ 1.33,patients have characteristics of HBeAg positive,HBV-DNA level≥105 copies/ml,liver function Child-Pugh B grade,BCLC B-C stage,with liver cirrhosis,with portal vein tumor thrombus,tumor diameter≥10cm,without preoperative antiviral treatment.Conclusion:1.Preoperative SIRI,APRI level can be used to predict postoperative survival of patients with hepatitis B-related liver cancer after TACE.When SIRI<1.03 or APRI<1.33,the survival time of patients is significantly prolonged(P<0.05)compared with SIRI≥1.03 or APRI≥1.33.When the two indexs are both below the critical value,the prognosis of patients will be better,while when both are higher than the critical value,the survival time of patients will be shorter and the prognosis was poor.2.The SIRI level of most patients one week after TACE is much higher than before and decrease happens to only a few of patients.The survival period of the index which increases than before is significantly longer than that of the lower group,suggesting that the prognosis of those with higher postoperative SIRI level is better.However,neither the increase or decrease for APRI has no obvious effect on the survival time of the patients,which may be related to the insufficient sample size.The result is worthy of further study3.The relationship between clinical features and survival of patients with hepatitis B-related liver cancer after TACE treatment showes that when HBeAg negative,HBV-DNA negative,liver function Child-Pugh A grade.BCLC 0-A stage,without liver cirrhosis,without portal vein tumor thrombus,tumor diameter≤5cm,with preoperative antiviral treatment,patients can have a better prognosis.Either HBV-DNA and HBeAg is positive or negative,antiviral therapy can prolong patient’s survival time.4.Relationship between preoperative SIRI,APRI level and patient’s clinical characteristics:The prognosis of different groups of SIRI and APRI is consistent with that of each clinical characteristic group.It indicates that SIRI and APRI are significantly related to the patient’s clinical characteristics,which suggests that SIRI and APRI have better prediction value for survival. |
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