| Objective:Bioelectrical impedance analysis(BIA)is a technique for measuring human moisture,and is widely used in clinical practice of body composition inspection and nutritional status assessment.Phase angle(PA)is an indicator of nutritional status derived from BIA,which is related to the stability of intracellular,extracellular fluid,and cell membranes.Studies have shown that PA is one of the factors affecting the survival of multiple tumors such as breast cancer and head and neck tumors.Low PA not only indicates poor nutritional status,but also is associated with poor prognosis.However,the significance of PA value in the assessment of primary liver cancer prognosis have not been reported.This study intends to explore the relationship between the PA of patients with primary liver cancer and body composition analysis other indicators and prognosis of patients,and further clarify the clinical significance of PA detection in patients with primary liver cancer.Methods:A retrospective analysis of 248 primary liver cancer patients who were admitted at the First Hospital of Jilin University from January 2015 to December 2019 and underwent bioelectrical impedance analysis.Collect patients' basic clinical data(gender,age,height,weight),tumor-related data(BCLC stage,metastasis),laboratory-related index data(hemoglobin,transferrin,C-reactive protein,retinol Binding protein,aspartate aminotransferase,alanine aminotransferase,?-glutamyl transpeptidase,alkaline phosphatase,alpha-fetoprotein,quantification of hepatitis virus,etc.)and survival data.Group according to the median phase angle(PA),compare the overall survival(OS),body composition analysis and other indicators of the two groups of patients and statistical analysis of factors affecting survival.Results:1.Normal information: A total of 248 patients with liver cancer were included,including 190 males and 58 females,aged 26 to 84 years,with an average age of 67.6 years.In the Child-Pugh classification of liver function,there were 209 in grade A,25 in grade B,and 14 in grade C.In the BCLC stage,there were 84 people in stage A,85 in stage B,and 79 in stage C.Group by median of phase angle,compared with the high PA group,the low PA group had lower intracellular water(20.45 L vs 23.56 L,P =0.038),extracellular water(13.38 L vs 14.57 L,P = 0.004),muscle mass(43.23 kg vs 48.87 kg,P=0.031),and lean body mass(45.88 kg vs 51.72 kg,P = 0.036).Aspartate aminotransferase,?-glutamyl transpeptidase,total bilirubin,direct bilirubin water,and cholesterol levels in low PA group were higher than those in high PA group(78.36U/L vs47.71U/L,P = 0.021;138.48 U/L vs108.45U/L,P = 0.018;30.7?mol/L vs19.76 ?mol/L,P = 0.001;13.92?mol/L vs6.49 ?mol/L,P = 0.000;4.31 mmol/l vs 4.04 mmol/l,P<0.001).Compared with the high PA group,the hemoglobin level in low PA group was lower(129.72g/L vs 144.31g/L,P = 0.042).2.Correlation: Pearson correlation analysis of the phase angle(PA)with the above indicators.The results showed: PA and albumin(r=0.286,P < 0.001),cholinesterase(r=0.319,P < 0.001),hemoglobin(r=0.391,P<0.001),height(r=0.196,P=0.002),body weight(r=0.342,P<0.001),intracellular water(r=0.499,P<0.001),extracellular water(r=0.300,P < 0.001),protein(r=0.494,P < 0.001),Inorganic salt(r=309,P < 0.001),muscle mass(r=0.438,P < 0.001),fat-free body weight(r=0.431,P < 0.001),upper arm circumference(r=0.28,P <0.001),body mass index(r=0.303,P < 0.001),basal metabolic rate(r=0.281,P<0.001),body cell mass(r=0.380,P<0.001),abdominal circumference(r=0.250,P < 0.001)are positively correlated;with prealbumin(r=-0.148,P=0.027),total bilirubin(r=-0.127,P=0.046),direct bilirubin(r=-0.145,P=0.023),age(r=-0.309,P<0.001),gender(r=-0.295,P < 0.001),PG-SGA score(r=-0.233,P=0.001)were negatively correlated;AST,ALT,?-GT,alkaline phosphatase,total protein,transferrin,retinol-binding protein,cholesterol,triglycerides,body fat,bone mineral content,and visceral fat area were not related.3.Survival data: The patients were followed up from the time of their own body composition analysis to death or observation end point(the follow-up time ended in December 2019).The median follow-up time was 53.5 months.The m OS of 248 patients was 70 months.The difference in m OS between the high PA group and the low PA group was statistically significant(70 months vs 54.6 months,P=0.004).The subgroup analysis showed that in BCLC stage A and B,the difference in survival between high PA and low PA was statistically significant(P = 0.0006,0.025).4.Multivariate analysis: Taking death as the outcome,the variables with statistical significance in univariate analysis were included,and COX regression analysis was performed.The results of multivariate analysis showed that aspartate aminotransferase,total bilirubin and clinical stage are independent risk factor that affect the prognosis of patients with primary liver cancer(P= 0.02,0.025,<0.001).5.Subgroup analysis: In BCLC stage A,the difference in m OS between the high PA group and the low PA group was statistically significant(70 months vs 60 months,P <0.001).The COX multivariate regression analysis of the variables showed that PA was an independent risk factor affecting the prognosis of patients with primary liver cancer BCLC stage A(P = 0.026);in stage B,the m OS in the low PA group was 60 months,and the high PA The m OS of the group was 70.2 months,and the difference was statistically significant(P = 0.025).The variables with statistical significance in the univariate analysis were analyzed by COX multivariate regression analysis.The results showed that PA was affecting the BCLC stage B of primary liver cancer Independent risk factors for patients' prognosis(P = 0.039).Conclusion: 1.Grouped according to the median of the phase angle,the intracellular water content,extracellular water content,muscle mass,and lean body mass of the two groups of patients were different.In terms of hematological indicators,aspartate aminotransferase,?-glutamyl transpeptidase,total bilirubin,direct bilirubin water,and cholesterol levels in the low PA group were higher than those in the high PA group,and the hemoglobin level in the low PA group Lower than the high PA group.2.PA is positively correlated with height,weight,abdominal circumference,albumin,cholinesterase,hemoglobin,and other indicators in the analysis of human composition;negatively correlated with age,gender,PG-SGA score,total bilirubin,and direct bilirubin.3.Patients in the low PA group had a higher survival time and patients in the PA group had a shorter survival time.PA is an independent risk factor affecting the prognosis of patients with primary liver cancer BCLC stage A and B. |
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