不同AFP水平下血清IL-1与肝癌根治术后早期复发和预后的关系

Association of serum interleukin-17 level with early recurrence and prognosis after radical surgery in hepatocellular carcinoma patients with different levels of alpha-fetoprotein

目的研究IL-17在不同AFP水平下的HBV相关肝细胞癌(HCC)中的表达情况以及其与HCC根治术后复发和预后的关系。方法收集新疆医科大学附属肿瘤医院2013年1月-2014年12月收治的HBV相关HCC行根治切除术的连续病例167例,另外选取肝血管瘤患者115例(其中HBV携带者83例)作为对照组。采用ELISA法检测167例HBV相关HCC血清中IL-17表达,采用电化学发光法检测血清AFP浓度,并分析IL-17的表达与不同AFP水平的关联性及其与HBV相关HCC患者根治切除术后复发和生存的关系。计数资料组间比较采用χ2检验,生存分析采用Kaplan-Meier相关性分析、Log-rank检验以及Cox比例风险模型。结果将HBV相关HCC患者以血清AFP水平分为2组,AFP<400 ng/ml组IL-17的阳性表达率为50.9%(58/114),AFP≥400 ng/ml组为34.0%(18/53),2组比较差异有统计学意义(χ~2=8.11,P=0.002)。AFP<400 ng/ml组和AFP≥400 ng/ml组患者术后无瘤生存期(34.1个月vs 13.4个月)、总体生存期(84.2个月vs 57.4个月)、1年内肿瘤复发率(28.9%vs 50.9%)比较差异均有统计学意义(χ~2值分别为10.34、3.13、10.89,P值均<0.05)。Kaplan-Meier分析发现,AFP<400 ng/ml的HBV相关HCC患者,IL-17阳性表达组术后1年复发率高于阴性表达组,无瘤生存期、总生存期均显著低于低表达组(χ2值分别为7.350、3.814、9.744,P值均<0.05)。Cox模型分析结果显示,IL-17阳性表达、血管癌栓、组织分化程度是影响HCC患者预后的相关因素(P值均<0.05)。结论 AFP<400 ng/ml的HBV相关HCC患者中IL-17阳性表达预示着早期复发和预后不良。

Objective To investigate the expression of interleukin-17（IL-17） in hepatitis B virus（HBV）-related hepatocellular carcinoma（HCC） with different levels of alpha-fetoprotein（AFP）,as well as its association with recurrence and prognosis after radical treatment for HCC.Methods A total of 167 patients with HBV-related HCC who underwent radical resection in The Affiliated Tumor Hospital of Xinjiang Medical University from January 2013 to December 2014 were enrolled,and 115 patients with hepatic hemangioma（including 83 HBV carriers） were enrolled as control group.ELISA was used to measure the serum level of IL-17 in 167 patients with HBV-related HCC,and electrochemical luminescence was used to measure the serum level of AFP.The correlation between the expression of IL-17 and the serum level of AFP was analyzed,as well as the association of the expression of IL-17 with recurrence and survival after radical resection of HCC.The chi-square test was used for comparison of categorical data between groups,and the Kaplan-Meier method,log-rank test,and Cox proportional hazards model were used for survival analysis.Results The patients with HBV-related HCC were divided into two groups according to the serum level of AFP,and there was a significant difference in the positive expression rate of IL-17 between AFP 400 ng/ml group and AFP≥400 ng/ml group [50.9%（58/114） vs 34.0%（18/53）,χ~2= 8.11,P = 0.002]; there were also significant differences between these two groups in disease-free survival（34.1 months vs 13.4 months,χ2= 10.34,P〈0.05）,overall survival（84.2 months vs 57.4 months,χ~2= 3.13,P〈0.05）,and tumor recurrence rate within 1 year（28.9% vs 50.9%,χ~2= 10.89,P〈0.05）.The Kaplan-Meier analysis showed that among the patients with HBV-related HCC and AFP 400 ng/ml,the patients with positive expression of IL-17 had a significantly higher recurrence rate within 1 year after surgery than those with negative expression of IL-17,as well as significantly shorter disease-free survival and overall survival than those with low expression of IL-17（χ~2= 7.350,3.814,and9.744,all P〈0.05）.The Cox proportional hazards model showed that positive expression of IL-17,tumor thrombus in vessels,and degree of tumor differentiation were influencing factors for the prognosis of HCC patients（all P〈0.05）.Conclusion For patients with HBV-related HCC and AFP 400 ng/ml,positive expression of IL-17 indicates early recurrence and poor prognosis.