【作者】 周晶；

【导师】 杨道锋；

【作者基本信息】 华中科技大学 ， 内科学（专业学位）， 2024， 硕士

【摘要】 目的:探索HALP评分及其变化能否评估肝细胞癌的预后。HALP评分是由血红蛋白、白蛋白、淋巴细胞和血小板组成的营养免疫评分系统。方法:第一部分纳入2016年5月至2017年6月于我院行手术切除的肝细胞癌患者,观察终点为随访截止期前患者因任何原因发生的死亡事件。使用Cox比例风险模型分析总生存期的风险因子。第二部分纳入2019年8月至2023年1月于我院行以免疫检查点抑制剂(Immune Checkmate Inhibitors,ICIs)为基础的多模式疗法治疗的肝细胞癌患者,观察终点为影像学提示疾病进展。使用logistic回归分析确定与总缓解率(Overall Response Rate,ORR)相关的危险因素。无进展生存期的风险因子分析使用Cox比例风险模型。结果:第一部分共273例患者,随访时间截止至2023年5月31日。通过Cox比例风险模型确定HALP评分(HR:1.708,95%CI:1.192,2.448)是总生存期的独立风险因子。患者为高HALP评分的3年和5年生存率分别是84.3%和63.4%,与之相比低HALP评分患者的分别是69.8%和47.5%,P=0.018。第二部分共212例患者,随访时间截止至2023年9月30日。通过logistic回归分析确定HALP评分与ORR独立相关(OR:0.436,95%CI:0.203,0.940)。通过Cox比例风险模型确定HALP评分(HR:1.718,95%CI:1.049,2.815)是无进展生存期(Progress-free Survival,PFS)的独立风险因子。高HALP评分患者的中位PFS为484天,显著高于低HALP评分患者的338天,P=0.024。基线低HALP评分的患者在治疗后仍下降具有相对最差的预后,基线低HALP评分的患者在治疗后仍为低HALP评分具有相对最差的预后。结论:HALP评分及其变化对不同分期、不同治疗方案的肝细胞癌有重要的预后预测作用。更多还原

【Abstract】 Objective:To explore whether the HALP score and its changes can evaluate the prognosis of hepatocellular carcinoma.HALP score is a nutritional immune scoring system composed of hemoglobin,albumin,lymphocytes,and platelets.Methods:The first part:Patients with hepatocellular carcinoma who underwent hepatectomy in our hospital from May 2016 to June 2017 were included.The primary endpoint was the death of the patients for any reason before the follow-up deadline.The Cox proportional hazard model was used to analyze the risk factors of overall survival.The second part:Patients with hepatocellular carcinoma who were treated by ICIs-based multimodal therapy in our hospital from August 2019 to January 2023 were included.The primary endpoint was the progress of the disease indicated by imaging.The logistic regression analysis was used to confirm the risk factors of the ORR.The Cox proportional hazard model was used to analyze the risk factors of PFS.Results:The first part A total of 273 patients were followed up until May 31^st,2023.The Cox proportional hazard model confirmed that the HALP score was an independent risk factor for overall survival（HR:1.708,95%CI:1.192-2.448）.The 3-year and 5-year overall survival of patients with a high HALP score was 84.3%and 63.4%respectively,while those with a low HALP score were 69.8%and 47.5%respectively,P=0.018.The second part A total of 212 patients were followed up until September 30^th,2023.Through logistic regression analysis,it was determined that the HALP score was independently related to the ORR of patients（OR:0.436,95%CI:0.203,0.940）.The Cox proportional hazard model confirmed that the HALP score（HR:1.708,95%CI:1.192-2.448）was an independent risk factor for PFS.The median PFS of patients with a high HALP score was 484 days,which was significantly higher than that of a low HALP score of patients with 338 days,P=0.024.Patients with a low HALP score at baseline still decrease after treatment,which has the worst prognosis.Patients with a low HALP score at baseline still have a low HALP score after treatment,which has the worst prognosis.Conclusions:The HALP score and its changes have important predictive value for the prognosis of hepatocellular carcinoma with different stages and different treatment schemes.更多还原