Objective: To explore the value of preoperative neutrophil-to-lymphocyte ratio (NLR) and γ-glutamyl transpeptidase-to-platelet ratio index (GPRI) for predicting the prognosis of patients with HBV-related intrahepatic cholangiocarcinoma (ICC) after radical resection. Methods: The data of 79 patients who underwent radical resection for HBV-related ICC in the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Xi'an Jiaotong University from January 2010 to December 2018 were retrospectively analyzed. Among them, 48(60.8%) patients were male and 31 (39.2%) patients were female, (56.9±11.2) years old. X-Tile statistical software was used to determine the best cut-off values of NLR and GPRI. The χ2 test was conducted to analyze the relationship between preoperative NLR and GPRI and the clinicopathological characteristics, and the Cox proportional hazard regression model was conducted for multivariate analysis. A nomogram prognostic prediction model was established based on independent risk factors screened by Cox regression model. Results: The best cut-off values of NLR and GPRI were 3.13 and 1.31 determined by the X-Tile software, respectively. With the best cut-off value, 79 patients were divided into NLR≤3.13 group (45 cases) and NLR>3.13 group (34 cases). GPRI≤1.31 group (54 cases) and GPRI>1.31 group (25 cases). Compared with the preoperative NLR ≤3.13 group, the proportion of patients with liver cirrhosis and atrophy, poor pathological differentiation, tumor diameter>5 cm and late TNM stage was significantly increased in the NLR>3.13 group (all P<0.05); Compared with preoperative GPRI ≤1.31 group, the proportion of patients with liver cirrhosis and atrophy was significantly increased in the GPRI>1.31 group (P=0.025). The postoperative overall survival time of the included patients was 2 to 126 months, with the median survival time being 18 months, and the 1, 3-year overall survival rates were 63.3%, 32.8%, respectively. Multivariate analysis showed that NLR, GPRI, liver cirrhosis and atrophy, and lymphatic metastasis were independent risk factors affecting the overall survival of patients with HBV-related ICC after radical resection (P<0.05). A nomogram prediction model was established based on independent risk factors, with the C-index of 0.750, and the prediction effect was close to the actual survival outcome of the patients. Conclusion: Preoperative peripheral blood NLR and GPRI can be used to predict the prognosis of patients with HBV-related ICC after radical resection.
目的： 探讨术前外周血中性粒细胞与淋巴细胞比值（NLR）和γ-谷氨酰转肽酶与血小板比值指数（GPRI）在乙型肝炎病毒（HBV）相关肝内胆管细胞癌（ICC）根治切除术后的预后预测价值。 方法： 回顾性分析2010年1月至2018年12月于西安交通大学第一附属医院肝胆外科因HBV相关ICC行根治切除术的79例患者的临床资料，其中男48例（60.8%），女31例（39.2%）；年龄（56.9±11.2）岁。采用X-Tile统计软件确定NLR和GPRI的最佳截断值。采用χ²检验分析术前NLR和GPRI与患者临床病理特征之间的关系。多因素生存分析采用Cox比例风险回归模型。以Cox回归模型筛选的独立危险因素建立列线图预后预测模型。 结果： X-Tile软件确定NLR和GPRI的最佳截断值分别为3.13和1.31，以最佳截断值为界，将79例患者分为NLR≤3.13组（45例）和>3.13组（34例）以及GPRI≤1.31组（54例）和>1.31组（25例）。与术前NLR≤3.13组患者比较，术前NLR>3.13组患者中肝脏硬化萎缩、病理为低分化、肿瘤直径>5 cm以及分期晚的比例明显增高（均P<0.05）；与术前GPRI≤1.31组患者比较，术前GPRI>1.31组患者中肝脏硬化萎缩的比例明显增高（P=0.025）。79例患者的生存时间为2~126个月，中位生存时间为18个月，1、3年生存率分别为63.3%和32.8%。多因素分析结果显示，NLR水平、GPRI水平、肝脏硬化萎缩和淋巴结转移情况为影响HBV相关ICC根治性切除术后患者总体生存期的独立因素（均P<0.05）。基于影响预后的独立危险因素建立列线图预测模型，模型一致性指数为0.750，预测效果接近患者实际生存结果。 结论： 术前外周血NLR和GPRI可用于HBV相关ICC根治性切除术后患者的预后预测。.