| Background and purpose:Primary liver cancer is one of the incidence rate malignant tumors in the world.At present,our country is a big country of hepatitis B,hepatitis B will lead to cirrhosis,and liver cancer will develop in the late stage of cirrhosis,so our country will also become a high incidence country of liver cancer.Hepatocellular carcinoma(HCC)is the most common histological type of liver cancer,accounting for more than 80%.At present,radical resection is still the first choice for the treatment of HCC,but the recurrence rate is still high and the prognosis is poor.Therefore,patients with HCC need an accurate prediction system to identify the risk of postoperative recurrence,so as to make refined guidance for the choice of postoperative treatment.A study published in Journal of Clinical Oncology in 2015,based on 1313 clinical data of patients with liver cancer in Japan,a new liver function evaluation grade,albumin bilirubin grade(ALBI),was proposed for the first time.It was found that the ALBI grade had a certain predictive value for the prognosis of patients with liver cancer and was superior to the traditional Child Pugh score.In recent years,it has been found that there is a close relationship between inflammation and tumor.Inflammatory indexes such as neutrophil to lymphocyte ratio(NLR)and platelet to lymphocyte ratio(PLR)have a certain predictive effect on the prognosis and survival of HCC.At the same time,alpha fetoprotein(AFP)commonly used in clinic has certain reference value for the prognosis and survival of patients with HCC.Recent studies have found that the comprehensive evaluation of multiple indicators is better than a single index,such as ALBI grading combined with other predictive indicators to assess HCC the overall survival time after surgery is better than a single ALBI grading method,but there is a lack of relevant clinical research in China.Therefore,the purpose of this study is to evaluate and compare the value of ALBI grade and ALBI grade combined with NLR,PLR and AFP in the prognosis of patients with HCC,so as to select the best treatment opportunity and treatment mode for surgeons in clinical work.Method:The data of 244 primary cases of HCC in the First Hospital of Jilin University from January 2013 to April 2015 were analyzed retrospectively.All cases were followed up to December 20,2019.General and clinical data of patients were collected.The survival data were analyzed by Kaplan Meier method,and then statistically significant single factor(P < 0.05)was included in Cox regression for multivariate analysis,and statistically significant prognostic factors were calculated according to P < 0.05.Patients with a preoperative ALBI grade of 1,2,or 3 were scored 0,1,or 2 respectively.Preoperative AFP ? 400 and AFP > 400 were divided into AFP low-level group and AFP high-level group with 0 and 1 respectively.According to the intercept values of NLR and PLR,NLR was divided into low-level group and high-level group,with 0 and 1 points respectively.PLR was divided into low-level group and high-level group,and scored 0 and 1 respectively.The ALBIPLR score is the ALBI score plus the PLR score.The ALBIAFP score is the ALBI score plus the AFP score.The ALBINLR score is the ALBI score plus the NLR score.Kaplan Meier method and AUC were used to analyze the prognostic value of different scoring systems.Result:1,The shortest overall survival time was 2 months,the longest overall survival time was 82 months,the average overall survival time was 40 months,and the median overall survival time was 42 months.The OS of 1,3,5 years after HCC operation was 76.6%,53.3%,29.1%.168 patients(68.9%)died during the follow-up period.2,The best cut-off points of preoperative NLR and PLR for predicting the total survival time of patients with HCC were 2.4 and 150,respectively3,After Kaplan Meier single factor analysis,the results showed that CA199 level,tumor maximum diameter,age,survival with tumor,vascular invasion,tumor differentiation,AFP level,NLR level,ALBI level,ALBIAFP score,ALBIPLR score,ALBINLR score were related to the total survival time of patients with HCC(P < 0.05),The results showed that the largest diameter of tumor,age,survival with tumor,vascular invasion,differentiation degree of tumor,ALBINLR level were independent risk factors for the total survival time of patients with HCC.4,By Kaplan Meier method,we found that the OS of one year,three years and five years were 81.7%,58.2% and 39.9% in NLR low-level group,68.1%,45.1% and 29.7% in NLR high-level group,P value was 0.035.The OS of the first,third and fifth year in the ALBI group was 85.4%,60.4% and 43.8%;the OS of the second,third and fifth year was 70.7%,50.0% and 32.1%;the OS of the third,third and fifth year was 75.0%,25.0% and 12.5%,P value was 0.019.In the ALBIAFP score,0 group had 91.5%,72.9% and 50.8% OS in one year,three years and five years;1 group had 74.6%,52.3% and 34.6% OS in one year,three years and five years;2 group had 66.0%,35.8% and 24.5% OS in one year,three years and five years;3 group had 50%,0%,0% OS in one year,three years and five years,P value was 0.001.In the ALBIPLR score,the OS of one year,three years and five years in group 0 was 84.4%,61.0% and 46.8%;the OS of one year,three years and five years in group 1 was 75.6%,52.6% and 31.9%;the OS of one year,three years and five years in group 2 was 60.7%,42.9% and 32.1%;the OS of one year,three years and five years in group 3 was 75%,0% and 0%,P value was 0.024.In the ALBINLR score,the OS of one year,three years and five years in group 0 was 86.4%,66.1% and 47.5%;the OS of one year,three years and five years in group 1 was 80.3%,52.8% and 36.2%;the OS of one year,three years and five years in group 2 was 57.4%,44.4% and 25.9%;the OS of one year,three years and five years in group 3 was 75%,0% and 0%,P value was 0.003.5,The prediction ability is compared by area under ROC curve(AUC),It was found that the AUC of 1,3,and 5-year survival predicted by ALBI grade was 0.594,0.566,and 0.599,with P values of 0.031,0.076,and 0.014;the AUC of 1,3,and 5-year survival predicted by ALBINLR was 0.639,0.594,and 0.608,with P values of 0.001,0.012,and 0.007;the AUC of 1,3,and 5-year survival predicted by ALBIPLR was 0.594;The AUC of 1,3 and 5-year survival predicted by ALBIPLR was 0.632,0.639 and 0.638,P value was 0.003,0.000 and 0.001.Conclusion:1,The independent risk factors for the prognosis of HCC are the maximum diameter of tumor,age,survival with tumor,vascular invasion,differentiation degree of tumor and ALBI-NLR level.2,The prognosis of hepatocellular carcinoma can be predicted by NLR?ALBI grade,ALBI-PLR score and newly established ALBI-NLR score and ALBI-AFP score.The higher the system grade,the worse the survival rate.3,The ALBI-NLR score was better than the other three scoring systems when the overall postoperative survival was predicted to be one year.ALBI-AFP is superior to the other three scoring systems in predicting the overall postoperative survival of liver cancer patients for three and five years. |
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