循环肿瘤细胞对肝癌射频消融术后复发的预测价值

目的研究分析射频消融术(RFA)前循环肿瘤细胞(CTC)预测肝癌术后复发的应用价值。方法收集2016年6月至2019年9月中山市人民医院收治的168例肝细胞癌患者,在RFA治疗前以Cyttel检测法分析患者外周血的CTC。利用X-tile软件的Kaplan-Meier模块确定CTC的最佳临界值,并分析CTC与术前临床参数的关系,Cox比例风险模型分析影响RFA术后复发的独立危险因素,采用Kaplan-Meier法绘制RFA术后复发曲线图明确CTC与RFA术后复发的关系。结果预测肝癌RFA术后复发的CTC最佳临界值为2个/3.2 ml。术前CTC与肿瘤结节数目、最大肿瘤直径、术前AFP水平以及中国肝癌临床分期(CNLC)有关(P<0.05)。术前CTC(HR=1.965,95%CI:1.314~2.937,P=0.001)、AFP水平(HR=1.743,95%CI:1.158~2.623,P=0.008)、PIVKA-Ⅱ(HR=1.559,95%CI:1.008~2.411,P=0.046)以及最大肿瘤直径(HR=1.994,95%CI:1.104~3.602,P=0.022)均是肝癌RFA术后复发的独立危险因素。术后复发率62.5%(105/168),CTC≤2个/3.2 ml患者的累积复发率明显低于CTC>2个/3.2 ml者(P<0.001)。结论术前CTC检测对预测肝癌射频消融术后复发有一定的应用价值及临床意义。

Predictive value of preoperative circulating tumor cells on recurrence of hepatocellular carcinoma after radiofrequency ablation

Objective To study and analyze the application value of preoperative circulating tumor cells(CTC)in predicting recurrence of hepatocellular carcinoma(HCC)after radiofrequency ablation(RFA).Methods From June 2016 to September 2019,the data of 168 HCC patients in Zhongshan City People’s Hospital were collected,and the peripheral blood CTC was analyzed by Cyttel test before RFA.Kaplan-Meier module of X-tile software was used to determine the cut-off value of CTC,so as to analyze the relationship between CTC and clinical parameters.Cox proportional hazards model was used to analyze the independent risk factors of recurrence after RFA.Kaplan-Meier method was used to clarify the relationship between CTC and recurrence after RFA.Results The optimal cut-off value of CTC for predicting recurrence of HCC after RFA was 2 cells per 3.2 ml.Preoperative CTC was correlated with the number of tumor nodules,the maximum tumor diameter,preoperative AFP level and clinical stage of liver cancer in China(CNLC)(P<0.05).Preoperative CTC(HR=1.965,95%CI:1.314-2.937,P=0.001),AFP level(HR=1.743,95%CI:1.158-2.623,P=0.008),PIVKA-Ⅱ(HR=1.559,95%CI:1.008-2.411,P=0.046)and maximum tumor diameter(HR=1.994,95%CI:1.104-3.602,P=0.022)were independent risk factors for recurrence of HCC after RFA.The postoperative recurrence rate was 62.5%(105/168).The cumulative recurrence rate of patients with CTC≤2/3.2 ml was significantly lower than that of patients with CTC>2/3.2 ml(P<0.001).Conclusion Preoperative detection of CTC has certain application value and clinical significance in predicting the recurrence of HCC after RFA.