肿瘤标志物在肝细胞癌合并门静脉癌栓诊断中的意义

Significant of tumor markers in diagnosis of hepatocellular carcinoma with portal vein tumor thrombus

目的:分析肿瘤标志物在肝细胞癌合并门静脉癌栓诊断中的意义。方法:回顾性分析1993年1月—2011年1月经影像学诊断为肝细胞癌并门静脉癌栓患者475例,同时随机选取同期经影像学诊断为肝细胞癌的手术患者977例。将甲胎蛋白(AFP)、癌胚抗原(CEA)、CA125作为实验因素。结果:2组一般情况差异无统计学意义(P>0.05)。ROC分析结果显示AFP、CA125的AUC面积分别达到0.814、0.783,AFP诊断界数值为32.91 ng/mL,CA125为113.65 U/mL。两者并联敏感性为0.909,特异性为0.410;串联时敏感性为0.520,特异性为0.970。当肝细胞癌患者满足AFP≥20 000 ng/mL时,其诊断敏感性为0.24,特异性为0.96,准确性为0.73,筛检阳性率0.76。结论:在检测肝细胞癌合并门静脉癌栓中尚无敏感性和特异性均令人满意的肿瘤标志物,AFP和CA125水平的检测对临床实践中判断是否合并门静脉癌栓有一定的指导意义。

Objective： To analysis tumor markers in diagnosis hepatocellular carcinoma with portal vein tumor thrombus. Method： Retrospective analysis 475 HCC patients with PVTT diag-nosed by imaging from January 1993 to January 2011 in our hospital, whilst randomly selected 977 HCC cases who underwent hepatectomy. The alpha-fetoprotein （AFP）, carcinoembryonic antigen ~CEA）, cancer antigen 125 （Ca125） were taken into account as experimental factors. Results： There was no significant difference in gender and age. ROC analysis showed that area under curve （AUC） of AFP, CA125 is 0.814 and 0.783,respectively, cut-off values were AFP=32.91 ng/mL and CA125=113.65 U/mL. When paralleled, sensitivity and specificity is 0.909 and 0.410. When seried, sensitivity and specificity 0.520 and 0.970. On condition the HCC meet AFP≥20 000 ng/mL, its di- agnostic sensitivity was 0.24, specificity 0.96, accuracy 0.73, positive rate of screening 0.76. Con. clusion The tumor markers commonly used in the detection of hepatocellular carcinoma with por- tal vein tumor thrombus had no satisfactory sensitivity and specificity. HCC patients who meet AFP〉 32.91 ng/mL and CA125〉113.65 U/mL or the AFP ≥20 000 ng/mL, its specificity of 0.97 and 0.96, respectively, can make sense in detecting PV-FI- patients.