肝细胞癌患者经肝动脉化疗栓塞术后AFP、脱-γ-羧基凝血酶原水平的变化及其对治疗效果的预测价值

Changes in alpha-fetoprotein and des-γ-carboxy-prothrombin after transarterial chemoembolization and their value in predicting treatment outcome

目的探讨AFP联合脱-γ-羧基凝血酶原(DCP)在预测经肝动脉化疗栓塞术(TACE)疗效中的价值。方法回顾性分析2016年10月-2018年3月在苏州大学附属第一医院经接受TACE治疗的85例肝细胞癌(HCC)患者的临床资料。分析TACE术前、连续2次TACE术后患者血清AFP、DCP的水平变化,以mRECIST标准评价TACE治疗效果,将AFP、DCP水平变化情况与同期影像学(mRECIST标准)进行对照分析。计量资料经正态性检验,符合正态分布的2组间比较采用两独立样本t检验;不符合正态分布的数据2组间比较采用Mann-Whitney U检验。计数资料2组间比较采用χ2检验;等级计数资料2组间比较采用Mann-Whitney U检验。采用Spearman相关性分析探索mRECIST分级与AFP、DCP水平变化之间的相关性。采用受试者工作特征曲线分析各指标诊断缓解组的价值。结果依据mRECIST标准,缓解组38例,未缓解组31例。缓解组治疗后AFP和DCP均明显低于未缓解组(Z值分别为-3. 366、-4. 065,P值均<0. 05)。缓解组△AFP、△DCP、△AFP%及△DCP%与未缓解组比较,差异均有统计学意义(Z值分别为-4. 837、-5. 597、-4. 210、-5. 851,P值均<0. 001)。mRECIST分期与△AFP、△DCP均呈明显的负相关(rs分别为-0. 552、-0. 593,P值均<0. 001)。△AFP%用于诊断缓解组的受试者工作特征曲线下面积为0. 796,△DCP%为0. 912,△AFP%+△DCP%联合为0. 921,△AFP%+△DCP%的诊断价值最大。结论联合分析TACE前后血清AFP和DCP水平变化可评估肝细胞癌TACE的治疗效果。

Objective To investigate the value of alpha-fetoprotein( AFP) combined with des-γ-carboxy-prothrombin( DCP) in predicting the therapeutic effect of transarterial chemoembolization( TACE). Methods A retrospective analysis was performed for the clinical data of 85 patients with hepatocellular carcinoma( HCC) who underwent TACE in The First Affiliated Hospital of Soochow University from October 2016 to March 2018. The serum levels of AFP and DCP were measured before TACE and after two consecutive sessions of TACE,and modified RECIST( mRECIST) was used to evaluate the therapeutic effect of TACE. The changes in AFP and DCP were compared with imaging findings based on mRECIST. The two-independent-samples t test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. The chi-square test was used for comparison of categorical data between two groups,and the Mann-Whitney U test was used for comparison of ranked data between two groups. A Spearman correlation analysis was used to investigate the correlation of mRECIST category with AFP and DCP. The receiver operating characteristic( ROC) curve was used to investigate the value of each index in the diagnosis of remission. Results According to the mRECIST criteria,38 patients achieved remission( remission group) and 31 did not achieve remission( non-remission group). After treatment,the remission group had significantly lower AFP and DCP than the non-remission group( Z =-3. 366 and-4. 065,both P < 0. 05). There were significant differences between the remission group and the non-remission group inΔAFP,ΔDCP,ΔAFP%,and ΔDCP%( Z =-4. 837,-5. 597,-4. 210,and-5. 851,all P < 0. 001). The mRECIST category was negatively correlated with ΔAFP and ΔDCP( rs=-0. 552 and-0. 593,both P < 0. 001). In the diagnosis of remission,ΔAFP% had an area under the ROC curve( AUC) of 0. 796,while ΔDCP% had an AUC of 0. 912 and ΔAFP% combined with ΔDCP% had an AUC of0. 921,suggesting that ΔAFP% combined with ΔDCP% had the highest diagnostic value. Conclusion Changes in serum DCP and AFP after TACE can be used to evaluate the outcome of HCC after TACE.