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[目的]探讨肝细胞肝癌(hepatocellular carcinoma,HCC)患者切除术前外周血系统炎症指数变化率(deltas ystematic inflammation index,Delta SII)对术后HCC复发的影响。[方法]回顾性分析接受HCC根治性切除术的患者123例。SII变化率(Delta SII)计算方式为:(术后SII-术前SII)/天数。术后SII为术后首次复查时采血检验所得数据。使用X-tile软件估算Delta SII对于术后复发的最佳决定值。Kaplan-meier法绘制生存曲线,Log-rank检验评估Delta SII在全部患者人群以及多种低危风险组中的价值。单因素Cox回归模型分析术前各临床参数对于术后复发的影响,有统计学意义的术前单因素进入Cox回归模型进行多因素分析。ROC曲线分析各参数对于复发预测的效能。[结果]截止2016年7月,123例患者中位随访时间43.60个月,共有55例(44.72%)患者复发。X-tile计算得到的Delta SII最佳切点为-2.64,其中Delta SII≤-2.64患者98例(79.67%),Delta SII>-2.64患者25例(20.33%)。单因素分析显示术前SII(P=0.041)、术后SII(P=0.035)以及Delta SII(P=0.027)是术后无瘤生存率的影响因素。多因素分析显示Delta SII是预测术后肿瘤复发的唯一独立危险因子(OR=2.49,95%CI:1.22~6.54,P=0.044)。对AFP阴性(≤400ng/ml)以及BCLC 0+A期的早期肝癌两个低复发风险亚组,Delta SII>-2.64依然是一个具有显著意义的复发评估指标(P均<0.05)。Delta SII>-2.64与多灶性肿瘤的发生具有显著的相关性(P=0.048)。ROC曲线分析显示Delta SII具有最大的复发预测效能。[结论 ]Delta SII是一个简便、高效、易检测、低成本的HCC切除术后早期复发预测指标,Delta SII>-2.64的HCC患者术后早期复发风险显著增加,在临床工作中检测Delta SII有利于临床制定更加有效的HCC综合治疗监测方案。
[Objective] To investigate the effect of deltas ystematic inflammation index (Delta SII) on the recurrence of postoperative HCC in patients with hepatocellular carcinoma (HCC). [Methods] A retrospective analysis of 123 patients undergoing radical resection of HCC. The SII rate of change (Delta SII) was calculated as: (postoperative SII - preoperative SII) / day. Postoperative SII for the first time after the review of the blood test data. X-tile software was used to estimate the optimal delta SII for postoperative recurrence. Survival curves were drawn using Kaplan-Meier method, and Log-rank test was used to assess the value of Delta SII in all patient groups and multiple low-risk groups. Univariate Cox regression analysis of preoperative clinical parameters on postoperative recurrence, statistically significant preoperative single factor into the Cox regression model for multivariate analysis. ROC curve analysis of the effectiveness of the parameters for recurrence prediction. [Results] As of July 2016, the median follow-up time of 123 patients was 43.60 months. A total of 55 patients (44.72%) had relapsed. X-tile computed Delta SII had a best cut-point of -2.64, of which 98 (79.67%) had Delta SII≤-2.64 and 25 (20.33%) had Delta SII> -2.64. Univariate analysis showed that preoperative SII (P = 0.041), postoperative SII (P = 0.035), and Delta SII (P = 0.027) were the influencing factors for postoperative tumor-free survival. Multivariate analysis showed that Delta SII was the only independent risk factor for prediction of postoperative tumor recurrence (OR = 2.49, 95% CI: 1.22-6.54, P = 0.044). Delta SII> -2.64 remained a significant recurrence assessment index for both low recurrence risk AFP negative (≤400ng / ml) and BCLC 0 + A early stage hepatocellular carcinoma (all P <0.05). Delta SII> -2.64 was significantly associated with the development of multifocal tumors (P = 0.048). ROC curve analysis showed that Delta SII has the greatest prognostic of recurrence. [Conclusion] Delta SII is a simple, effective, easy to detect, low cost prognostic indicator of early recurrence after HCC resection. Patients with HCC with Delta SII> -2.64 have a significantly increased risk of early recurrence after surgery. Delta SII is detected in clinical practice Conducive to the clinical development of more effective HCC comprehensive treatment monitoring program.