经导管肝动脉化疗栓塞术治疗肝细胞癌疗效及复发预测

目的探讨肝细胞癌(HCC)患者经导管肝动脉化疗栓塞术(TACE)前、术后脱γ-羧基凝血酶原(DCP)、甲胎蛋白异质体(AFP-L3)、甲胎蛋白(AFP)的变化及其与预后关系。方法纳入96例接受TACE作为初始治疗的HCC患者,分别于术前,术后4~5周及术后6~12个月检测血清DCP、AFP-L3、AFP等水平。根据术后CT或磁共振结果分为复发组和未复发组,观察两组术前和术后各指标的动态变化。应用广义估计方程(GEE)评估时间因素对肿瘤标志物作用的影响。应用受试者工作特征(ROC)曲线分析各指标对评估TACE疗效及复发的意义。结果HCC患者在接受TACE后的4~5周DCP水平为45.0(16.5~286.1)AU/L,显著低于术前86.5(22.6~917.8)AU/L,P<0.001];AFP-L3水平为6.8(0.5~26.1)ng/mL,显著低于术前12.5(0.5~54.3)ng/mL,P<0.05]。DCP、AFP-L3和AFP水平均显著影响术后复发情况,且时间与AFP的交互项具有显著性(P<0.05),AFP作为预测指标的作用受时间因素影响。术前和术后4~5周时DCP的AUC分别为0.809和0.819,术后6~12个月AFP-L3的AUC为0.765,均具有较高预测HCC复发的价值。在多种指标联合检测中,术前AST/ALT+DCP+AFP-L3的AUC为0.930,优于单一标志物(P<0.05);在术后4~5周和6~12个月,DCP+AFP-L3+AFP+AST/ALT(0.874)和DCP+AFP+AFP-L3+ALB(0.817)预测复发的价值较高。结论联合检测血清DCP和AFP-L3对于预测TACE后HCC复发具有较高临床价值,部分其他实验室指标可辅助应用于预后预测。

Prediction of efficacy and recurrence after transcatheter arterial chemoembolization in treating hepatocellular carcinoma

Objective To evaluate the utility of serum DCP,AFP-L3 and AFP levels measured before and after transcatheter arterial chemoembolization(TACE)as predictors of hepatocellular carcinoma(HCC)recurrence.Methods 96 HCC patients undergoing TACE as initial treatment were included.Serum DCP,AFP and AFP-L3 levels besides other indicators were tested before,4-5 weeks and 6-12 months after TACE.All HCC patients were divided into groups with or without recurrence according to CT images and the changes of indicators were compared respectively.The GEE model was used to find the statistical significance of a time effect and tumor makers.The area under the receiver operating characteristic(ROC)curve(AUC)was used to assess their abilities to predict recurrence after TACE.Results In HCC patients,serum DCP level 4-5 weeks after TACE was 45.0(16.5-286.1)AU/L,significantly lower than before TACE86.5(22.6-917.8)AU/L,P<0.001];AFP-L3 level 4-5 weeks after TACE was 6.8(0.5-26.1)ng/mL,significantly lower than before TACE12.5(0.5-54.3)ng/mL,P<0.05].DCP,AFP-L3 and AFP significantly affected the recurrence outcome,and the interaction term AFP*time was significant(P<0.05).AFP effects were different when time changed.DCP before and 4-5 weeks after TACE and AFP-L36-12 months after TACE had the greatest value for predicting recurrence,with the AUC of 0.809,0.819 and 0.765.Among the combinations of biomarkers,AST/ALT+DCP+AFP-L3 before TACE(0.930),DCP+AFP-L3+AFP+AST/ALT(0.874)and DCP+AFP+AFP-L3+ALB(0.817)at 4-5 weeks and 6-12 months after TACE,had certain value for predicting HCC recurrence.Conclusion Serum DCP and AFP-L3 have great potential for predicting HCC recurrence after TACE,while some other biomarkers can be applied as supplements.