术前CALLY指数、SII水平对肝细胞肝癌手术切除的预后评估价值

Prognostic Value of Preoperative CALLY Index and SII Level in Hepatocellular Carcinoma Resection

摘要: 目的：探讨术前C-反应蛋白–白蛋白–淋巴细胞指数(C-reactive protein-albumin-lymphocyte index, CALLY index)、系统免疫炎症指数(systemic immune-inflammation index, SII)评估肝细胞肝癌(hepatocellular carcinoma, HCC)患者术后预后的价值。方法：回顾性分析2018年1月~2020年12月于青岛大学附属医院初次行根治性手术治疗的94例HCC患者，依据手术前1周内最近一次化验结果计算出CALLY指数和SII，利用受试者工作曲线(receiver operating characteristic curve，ROC曲线)确定术前CALLY指数和SII的最佳临界值，并根据最佳临界值把病人分为高CALLY指数组和低CALLY指数组、高SII组和低SII组，使用χ2检验分析不同组别HCC患者基本资料的差异，使用Kaplan-Meier法和Log-Rank检验绘制并检验不同组别患者的生存曲线，使用Cox回归比例风险模型进行单因素和多因素的分析。结果：通过ROC曲线计算出术前CALLY指数的最佳临界值为3.90，将病人分为低CALLY指数水平组(<3.90，47例)和CALLY指数高水平组(≥3.90，47例)；术前SII的最佳临界值为492.31，将病人分为低SII水平组(<492.31，75例)和高SII水平组(≥492.31，19例)。与高CALLY指数水平组相比，低水平组的肿瘤直径较大、TNM分期更晚(P < 0.05)，与低SII水平组相比，高水平组的患者年纪更大、肿瘤直径较大(P < 0.05)。单因素结果分析显示，CALLY指数、SII、是否复发与HCC患者的预后有关(P < 0.05)。多因素分析结果显示，CALLY指数水平是影响肝癌预后的独立危险因素(P < 0.05)。结论：CALLY指数低水平是影响HCC患者预后的独立风险因素。术前CALLY指数高水平表明肝细胞肝癌TNM分期处在更早期，肿瘤直径更小；术前SII低水平表明肝细胞肝癌肿瘤直径更小。术前CALLY指数高水平、SII低水平HCC患者的生存时间更长。

Abstract: Objective: To investigate the value of preoperative C-reactive protein-albumin-lymphocyte index (CALLY index), systemic immune-inflammation index (SII) in assessing the prognosis of patients with hepatocellular carcinoma (HCC). Methods: Retrospective analysis of 94 HCC patients who un-derwent radical surgery for the first time in the Affiliated Hospital of Qingdao University from Janu-ary 2018 to December 2020, CALLY index and SII were calculated based on the results of the most recent blood test within 1 week before surgery, and the optimal critical values of preoperative CALLY index and SII were determined by using the receiver operating characteristic (ROC) curve. The ROC curve was used to determine the optimal preoperative thresholds of CALLY index and SII, and patients were divided into high CALLY index and low CALLY index groups, and high SII and low SII groups according to the recent thresholds, and differences in the basic data of HCC patients in different groups were analysed using the χ2 test, and differences in the basic data of HCC patients in different groups were plotted and tested using the Kaplan-Meier method and the Log- Rank test. Survival curves of patients in different groups were analysed using Cox regression proportional risk model for univariate and multivariate analyses. Results: The optimal critical value of preoperative CALLY index was calculated as 3.90 by ROC curve, and patients were divided into low CALLY index level group (<3.90, 47 cases) and high CALLY index level group (≥3.90, 47 cases); the optimal criti-cal value of preoperative SII was 492.31, and patients were divided into low SII level group (<492.31, 75 cases) and high SII level group (≥492.31, 19 cases). The low level group had larger tumour diameters and later TNM staging compared to the high CALLY index level group (P < 0.05), and patients in the high level group were older and had larger tumour diameters compared to the low SII level group (P < 0.05). Univariate analysis of the results showed that CALLY index, SII, and the presence of recurrence were associated with the prognosis of HCC patients (P < 0.05). Multifac-torial analysis of the results showed that the level of CALLY index was an independent risk factor affecting the prognosis of hepatocellular carcinoma (P < 0.05). Conclusion: The low level of CALLY index is an independent risk factor affecting the prognosis of HCC patients. A high preoperative CALLY index indicates that the TNM stage of hepatocellular carcinoma is earlier and the tumor di-ameter is smaller. Low preoperative SII levels indicate that hepatocellular carcinoma tumors are smaller in diameter. The survival time of HCC patients with high preoperative CALLY index and low preoperative SII was longer.