关键词: 肝肿瘤, 中性粒细胞与淋巴细胞比值, 肿瘤坏死因子α, 经动脉化疗栓塞术, 微波消融

Abstract:

Objective To explore the predictive value of neutrophil-to-lymphocyte ratio （NLR） and tumor necrosis factor -α （TNF-α） level on the therapeutic effect of transcatheter arterial chemoembolization （TACE） combined with microwave ablation in patients with massive liver cancer. Methods The medical records of 106 patients with massive liver cancer who underwent TACE combined with microwave ablation treatment in the Affiliated Hospital of Weifang Medical University from February 2020 to February 2023 were retrospectively analyzed. The efficacy was evaluated 6 weeks after surgery， and the patients were divided into remission group and non-remission group according to the therapeutic effect. The levels of NLR and TNF-α in the two groups were detected before surgery， 3 days after surgery and 7 days after surgery. Point two column correlation was used to analyze the relationship between the levels of NLR and TNF-α in different time periods and the therapeutic effect of TACE combined with microwave ablation in patients with massive liver cancer. The receiver operator characteristic （ROC） curve was drawn to analyze the predictive value of NLR and TNF-α levels in different time periods for the therapeutic effect of TACE combined with microwave ablation in patients with massive liver cancer. Results Six weeks after surgery， out of 106 patients with massive liver cancer， 13 achieved complete remission， 48 achieved partial remission， 20 experienced disease progression， and 25 remained stable. The overall remission rate was 57.55% （61/106）. Before surgery， the levels of NLR [（2.26±0.13） vs. （2.43±0.12）， t=6.87， P<0.001] and TNF-α [（36.20±4.38） pg/ml vs. （42.74±5.74） pg/ml， t=6.66， P<0.001] in the remission group （n=61） were lower than those in the non-remission group （n=45）， with statistically significant differences. At 3 days after surgery， there were no statistically significant difference in the levels of NLR [（6.16±3.22） vs. （6.22±3.30）， t=0.09， P=0.925] or TNF-α [（48.84±7.22） pg/ml vs. （49.13±7.34） pg/ml， t=0.20， P=0.840] between the remission group and the non-remission group. At 7 days after surgery， the levels of NLR [（2.60±0.18） vs. （2.82±0.26）， t=5.15， P<0.001] and TNF-α [（38.20±6.30） pg/ml vs. （45.57±5.79） pg/ml， t=6.16， P<0.001] in the remission group were lower than those in the non-remission group， with statistically significant differences. There were statistically significant differences in NLR and TNF-α levels before surgery， 3 days and 7 days after surgery between the remission group and the non-remission group （F=82.43，P<0.001； F=54.45，P<0.001； F=76.23，P<0.001； F=15.61，P<0.001）. Further pair-to-pair comparison showed that the levels of NLR and TNF-α were higher in both groups 3 and 7 days after surgery than before surgery， but the levels of NLR and TNF-α were lower in both groups 7 days after surgery than 3 days after surgery， with statistically significant differences （all P<0.005）. Point two column correlation analysis showed that NLR level， TNF-α level and the efficacy of TACE combined with microwave ablation in patients with massive liver cancer were significantly positively correlated before and 7 days after surgery （r=0.42， P<0.001； r=0.49， P<0.001； r=0.43， P<0.001； r=0.46， P<0.001）. ROC curve showed that the area under the curve （AUC） of NLR and TNF-α alone in predicting the efficacy of TACE combined with microwave ablation in patients with massive liver cancer before and 7 days after surgery was 0.750 （95%CI： 0.656-0.844）， 0.788 （95%CI： 0.699-0.877）， 0.751 （95%CI： 0.652-0.850）， 0.788 （95%CI： 0.700-0.876）， respectively. The AUC of combined prediction of NLR and TNF-α before and 7 days after surgery were 0.818 （95%CI： 0.736-0.900） and 0.813 （95%CI： 0.730-0.897）， respectively. There were no statistically significant differences in the AUC values of NLR and TNF-α alone or in combination for predicting the therapeutic effect of TACE combined with microwave ablation in patients with massive liver cancer before and 7 days after surgery （all P>0.05）. Conclusions The levels of NLR and TNF-α before and 7 days after surgery are related to the effect of TACE combined with microwave ablation in patients with massive liver cancer， and the combination of NLR and TNF-α levels before and 7 days after surgery has certain value in predicting the effect of TACE combined with microwave ablation in patients with massive liver cancer.

Key words: Liver neoplasms, Neutrophil-to-lymphocyte ratio, Tumor necrosis factor-alpha, Transcatheter arterial chemoembolization, Microwave ablation