| Objective The purpose of this study was to investigate the prognostic value of serum glutamyl transpeptidase(GGT)/ prealbumin(PA)ratio GPR in predicting postoperative survival and recurrence in patients with hepatocellular carcinoma(HCC),and whether GPR combined with other prognostic indicators can improve the ability to predict the prognosis of HCC patients.Methods A retrospective study was conducted on 212 patients with HCC who underwent radical hepatectomy in the first affiliated Hospital of Inner Mongolia Medical University from January 1,2011 to December 31,2019.The clinicopathological data of the patients were collected and followed up.The best cut-off values of GPR,NLR(ratio of neutrophil count to lymphocyte count)and LMR(ratio of lymphocyte count to monocyte count)were determined by X-tile software.GPR was divided into high ratio group and low ratio group,and the correlation between GPR and clinicopathological features was analyzed.Kaplan-Meier method was used to analyze the survival rate and recurrence-free survival rate of GPR,NLR and LMR.Cox proportional hazard regression model was used to analyze the independent risk factors affecting the survival and recurrence of patients with HCC.The patients whose GPR and NLR were higher than the cut-off value were assigned as 2 points according to GPR-NLR score,while those with GPR and NLR lower than the cut-off value were 0,and the rest was scored as 1 point.The prognostic values of GPR,NLR,LMR and GPR-NLR were compared by time-dependent receiver working curve(t-ROC),and Kaplan-Meier and Log-rank methods were used to analyze the survival of GPR-NLR.Results Among the 212 patients included in the study,there were 156 males and 56 females with an average age of(57.0 ±10.34)years.The median follow-up period was 41 months(9-67 months).A total of 84 patients died of tumor progression during the follow-up period.The results of X-tile analysis showed that the best cutoff values of GPR,NLR and LMR were3.2,2.6,2.5 respectively.Compared with GPR ≤ 3.2group,the proportion of patients with multiple tumors,tumor diameter > 5cm,poor differentiation,AFP > 400ug/L,LMR <2.5,NLR > 2.6,liver cirrhosis and BCLC grade B in high GPR ratio group was significantly higher than that in BCLC grade B group(all P < 0.001).The 1-,2-,3-and 5-year survival rates of patients with high GPR and low GPR were 98.2%,87.6%,64.3%,37.4% and 99.0%,97.0%,90.6% and 54.5%,respectively,and the difference was statistically significant(P <0.001).The 1-3-year recurrence-free survival rates of patients in high GPR group and low GPR group were 90.0%,38.2%,12.7% and 97.0%,69.3%,32.3%,respectively,and the difference was statistically significant(P < 0.001).Univariate and multivariate analysis showed that multiple tumors,GPR and NLR were independent risk factors for postoperative survival and recurrence in patients with HCC.Time-dependent ROC curve showed that GPR was superior to NLR(0.754 vs 0.657)and LMR(0.754 vs 0.619)in predicting 3-year survival rate.The prognostic value of GPR-NLR was significantly better than that of NLR(0.746 vs0.616,P < 0.001),but there was no significant difference compared with GPR(0.746 vs 0.44).The median survival time and median recurrence-free time of patients with GPR-NLR score 2were 37 months and 17 months respectively,and the 1-,2-,3-and 5-year survival rates were88.1%,63.8%,51.7% and 11.9%,respectively.The 1-3-year relapse-free survival rates were86.7%,29.7% and 10.1%,respectively.Conclusion Preoperative GPR,preoperative NLR and multiple tumors are independent risk factors affecting the prognosis of patients with HCC.GPR can be used to predict the survival and recurrence of patients with HCC.The score GPR-NLR based on GPR and NLR can improve the predictive power of GPR to some extent and can be used as a reference for prognosis evaluation.This score may help to improve the predictive ability of clinical indicators used to predict postoperative survival and recurrence in patients with HCC,so as to assist doctors in making clinical decisions and optimizing treatment plans. |
