AFP含量和寄生血管对中晚期肝癌患者TACE治疗的影响

Association of alpha fetoprotein levels and presence of parasitical blood vessels with response to TACE in patients with advanced liver cancer

目的:评价血清甲胎蛋白(alpha fetoprotein,A F P)含量变化和寄生血管存在对中晚期肝癌经导管动脉化疗栓塞术(transarterial chemoembolization,TACE)治疗的影响.方法:临床上病理学、影像学和肿瘤分子标志物检测,确诊163例中晚期肝癌的患者,在行TACE治疗前后用放射酶联免疫法检测患者血清AFP含量变化以及TACE治疗前行供血动脉CT血管造影(computer tomography angiography,CTA)检查,了解肝癌的寄生血管供血动脉情况.结果:在163例患者中,有131例AFP阳性,经TACE治疗后,其中82例AFP降低,有效治疗(1年生存以上)率为87.8%(72/82);13例AFP升高,有效治疗率为30.8%(4/13);36例AFP含量没有显著变化,有效治疗率为58.3%(21/36).32例AFP阴性患者的有效治疗率为100%(32/32);分析显示,AFP降低或AFP阴性的患者的有效治疗率均显著性高于AFP升高或不变的患者(P<0.01).CTA成像显示在163例患者中,有56例患者有寄生血管存在(AFP阳性53例,AFP阴性3例),经与数字减影血管造影(digital subtraction angiography,DSA)检查对照,吻合率100%.经TACE治疗后,无寄生血管患者有效治疗率为78.5%(84/107),而有寄生血管患者有效治疗率则为41.1%(23/56),两者比较有显著性差异(P<0.05);分析AFP含量与寄生血管存在的相关性表明,AFP阳性患者有寄生血管存在率为40.1%(53/131),而AFP阴性患者有寄生血管存在率为9.4%(3/32),两者比较有显著性差异(P<0.01).结论:血清AFP含量高和有寄生血管供应是导致TACE治疗中晚期肝癌患者效果不良的重要因素;AFP含量升高与肝癌组织寄生血管生成有关;联合AFP含量监测和CTA检查能评价TACE治疗中晚期肝癌患者的价值.

AIM：To assess the value of alpha fetoprotein（AFP） levels and presence of parasitical blood vessels in evaluating response to transarterial chemoembolization（TACE） in patients with advanced liver cancer.METHODS：One hundred and sixty-three patients who were diagnosed with advanced liver cancer by pathology,iconography and tumor molecular biomarker detection and underwent TACE were included in this study.Serum levels of AFP were detected by radioactive enzymelinked immunoassay.Computer tomography angiography（CTA） was used to detect parasitical angiogenesis.RESULTS：Of 131 AFP-positive patients before TACE,82 had decreased AFP after TACE,and the response rate（survival time over one year） was 87.8%（72/82）;13 had increased AFP,and the response rate was 30.8%（4/13）;36 had unchanged AFP,and the response rate was 58.3%（21/36）.In contrast,the response rate was 100%（32/32） in 32 AFP-negative patients.The response rate was significantly higher in AFPnegative patients and patients with decreased AFP than in those with increased or unchanged AFP（P 0.01）.Fifty-six patients developed parasitical blood vessels（including 53 AFP-positive and 3 AFP-negative patients）.After TACE,the response rate was significantly higher in patients without parasitical blood vessels than in those having parasitical blood vessels（78.5% vs 41.1%,P 0.05）.The percentage of AFP-positive patients having parasitical blood vessels was significantly higher than that of AFP-negative patients having parasitical blood vessels（40.1% vs 9.4%,P 0.01）.CONCLUSION：High serum levels of AFP and presence of parasitic blood vessels are associated with a poor response to TACE in patients with advanced liver cancer.Measurement ofAFP concentration and detection of parasitical angiogenesis by CTA may be used to evaluate the response to TACE therapy in patients with advanced liver cancer.