晚期肝癌患者血清转化生长因子β1在肝动脉化疗栓塞术前后变化及对预后的意义

Changes in serum transforming growth factor β1 level in patients with advanced primary hepatic carcinoma before and after transcatheter arterial chemoembolization and its prognostic significance

目的:探讨晚期原发性肝癌(PHC)患者接受肝动脉化疗栓塞术(TACE)治疗前后转化生长因子β1(TGF-β1)水平变化及其对预后的意义。方法:选择2012年6月—2016年1月期间在郑州人民医院进行TACE治疗的晚期PHC患者116例,检测患者术前与术后1、7、30 d时的血清TGF-β1水平,根据预后随访情况分析各时间点TGF-β1水平与PHC患者复发转移、生存期的关系。结果:全组患者中,术后1 d的TGF-β1水平较术前明显升高,术后7、30 d则明显降低(均P<0.05);术后复发/转移患者(75例)与无进展患者(41例)术前和术后1、7 d时的TGF-β1水平无明显差异(均P>0.05),但术后30 d时明显高于无进展组患者(268.3 pg/mL vs.200.4 pg/mL,P=0.001);Kaplan-Meier生存分析显示,术前、术后30 d的TGF-β1水平以及癌灶最大直径、癌灶个数是患者生存期的影响因素(均P<0.05),多因素Cox回归分析显示术后1个月TGF-β1水平(OR=2.820,95%CI=1.559~5.102,P=0.001)以及癌灶最大直径(OR=2.063,95%CI=1.152~3.694,P=0.015)是PHC患者的独立预后因素。结论:TGF-β1水平变化与晚期PHC患者TACE后结局密切相关,TACE术前及术后30 d时的TGF-β1水平对预后有一定提示意义,高TGF-β1水平患者预后不良的风险大于低水平患者。

Objective： To investigate the changes in serum transforming growth factor β1 （TGF-β 1） level in patients with advanced primary hepatic carcinoma （PHC） before and after transcatheter arterial chemoembolization （TACE）and its prognostic significance. Methods： One-hundred and sixteen patients with advanced PHC undergoing TACE in the People＇s Hospital of Zhengzhou from June 2012 to January 2016 were enrolled. The serum TGF-β1 levels of the patients were determined at 1 d before and 1, 7 and 30 d after TACE. The relations of serum TGF-β1 level with recurrence/ metastasis and survival time of the patients were analyzed according to the follow-up findings and TGF-β1 level at each defined time point. Results： In the entire group of patients, the TGF-β1 level was significantly higher at 1 d after TACE, while it was significantly lower at 7 or 30 d after TACE than that of preoperative value （all P〈0.05）; the TGF-β1 level in patients with postoperative recurrence/metastasis （75 cases） showed no significant difference with that in patients with progression-flee survival （41 cases） at either preoperative or postoperative 1 or 7 d assessment （all P〉0.05）, but was significantly higher than that in patients with progression-flee survival 30 d after TACE （268.3 pg/mL vs. 200.4 pg/mL, P=0.001）. The results of Kaplan-Meier analysis showed that the TGF-β1 level before and 30 d after TACE along with the maximum diameter of the tumor and lesion number were the influential factors for survival time of the patients （all P〈0.05）, and the results of multivariate Cox regression analysis showed that the postoperative 30 d TGF-β1 level （OR=2.820, 95% CI=1.559-5.102, P=0.001） together with the maximum diameter of the tumor （OR=2.063, 95% CI=1.152-3.694, P=0.015） were the independent prognostic factors. Conclusion： The change in TGF-β1 level is closely related to the outcomes of patients with advanced PHC after TACE. The preoperative and postoperative day 30 TGF-β1 levels have certain implications for prognosis, and patients with high TGF-β 1 level may have a higher risk of poor prognosis than those with low TGF-~ 1 level.