联合检测血浆骨桥蛋白和细胞间黏附分子对预测肝细胞癌患者术后预后的价值

The prognostic significance of preoperative plasma level of osteopontin in combination with intercellular adhesion molecule-1 for patients with hepatocellular carcinoma

目的研究联合检测血浆骨桥蛋白(OPN)和细胞间黏附分子-1(ICAM-1)表达水平在预测原发性肝细胞癌(HCC)患者术后转移复发以及生存中的临床应用价值。方法应用酶联免疫吸附试验(ELISA)检测75例HCC患者术前血浆中OPN和ICAM-1的浓度,分析其表达水平与患者术后复发及预后的关系。结果OPN和ICAM-1在所有75例HCC患者外周血中均有表达。有HCC复发患者的血浆OPN和ICAM-1表达水平明显高于无复发患者(OPN分别为210.40ng/ml和154.86ng/ml,P=0.001;ICAM-1分别为1011.23ng/ml和747.49ng/ml,P=0.027)。OPN高表达组患者的平均生存时间(OS)和无瘤生存时间(DFS)较无复发组患者明显缩短(OS:625d∶808d,P=0.0006;DFS:433d∶674d,P=0.0003);ICAM-1高表达组患者的平均OS和DFS时间也较低表达组患者明显缩短(651d和794d,P=0.0269;489d和642d,P=0.0248)。OPN和ICAM-1两者水平均高和均低的患者术后2年复发率分别为87.50%和28.00%(P<0.001)、2年生存率分别为37.50%和88.00%(P=0.0001)、2年无瘤生存率分别为12.50%和76.00%(P=0.0001)。结论血浆OPN与ICAM-1和肝癌患者术后复发及预后有关;联合应用血浆OPN和ICAM-1可以准确筛选出具有较高和较低复发及预后风险的患者。

Objective To investigate the enhanced predictive activity of preoperative plasma osteopontin （OPN） level in combination with intercellular adhesion molecule-1 （ICAM-1） for recurrence and prognosis of patients after resection of hepatocellular carcinoma （ HCC ）. Methods A total of 75 patients received liver resection for HCC from August 2001 to December 2001 in authors＇ institute were enrolled in this study. The preoperative plasma levels of OPN and ICAM-1 were detected by ELISA, and the association of them combination with the recurrence and prognosis of HCC patients was analyzed. Results OPN and ICAM-1 could be detected in all of the plasma samples of the tested patients. A significantly higher OPN level and ICAM-1 level were found in plasma of patients who were found to have HCC recurrence during the follow-up time compared with those without recurrence （ 210.40 vs. 154. 86 ng,/ml, P = 0. 001; 1011.23 vs. 747.49 ng,/ml, P = 0. 027 ）. A significant difference of OS and DFS were found in different subgroups with higher or lower level of OPN （625 vs. 808 days, P = 0. 0006; 433 vs. 674 days, P = 0. 0003 ） ; and a similar situation was found in patients of high- and low- ICAM-1 levels （651 vs. 794 days,P =0. 0269; 489 vs. 642 days, P = 0. 0248 ）. The 2-year recurrence rates of the patients with higher and lower plasma levels of both OPN and ICAM-1 were 87.50% and 28.00% （ P 〈 0. 001 ）, respectively; and the 2-year OS rates were 37. 50% and 88.00% （ P = 0. 001 ） , and the 2-year DFS rates were 12. 50% , and 76. 00 （ P = 0. 001 ）, respectively. Conclusions The evaluation of preoperative plasma level of OPN or ICAM-1 may be helpful to predict the recurrence and prognosis of HCC patients in advance. The assessment of OPN level in combination with ICAM-1 could stratify patients into groups with different potentials of HCC recurrence and different outcomes more accurately than OPN or ICAM-1 individually.