治疗前BALAD-2模型风险指数在肝细胞癌预后中的应用价值

Clinical utility of BALAD-2 models in predicting prognosis in hepatocellular carcinoma before treatment

目的:探讨治疗前BALAD-2模型风险指数在肝细胞癌(HCC)预后评估中的价值。方法:收集2014年12月至2015年3月福建省肿瘤医院收治的125例未经治疗的HCC患者血清样本。分别采用化学发光免疫、电化学发光和微量离心柱法检测血清异常凝血酶原(DCP)、甲胎蛋白(AFP)和甲胎蛋白异质体(AFP-L3)等标志物水平,同时检测ALB、TBIL等肝功能指标,建立BALAD-2模型。收集患者临床诊疗数据,并对患者生存状态进行随访,计算BALAD-2模型对无进展生存期(PFS)和总生存期(OS)的风险指数,用SPSS16.0软件进行统计分析。结果:HCC患者的乙肝病毒感染状态、肝硬化情况、肿瘤大小和数量等均与BALAD-2模型风险指数分级相关(P均<0.05)。所有125例患者中位PFS为3.2个月,3年无进展生存率为9.6%;中位OS为4.0个月,3年总生存率为16%。患者的生存时间、生存率均与BALAD-2模型风险指数显著相关,并随模型风险指数的升级而降低。亚组分析显示,BALAD-2模型Ⅳ级高风险患者的中位PFS为2.0个月,中位OS为2.6个月,3年无进展生存率和总生存率均为3.5%,显著低于低风险患者(P均<0.05)。多因素Cox回归分析显示,治疗前BALAD-2模型风险指数Ⅳ级高风险、肿瘤直径>5 cm均为患者无进展和总体生存率低的独立危险因素(P均<0.05)。结论:治疗前BALAD-2模型风险指数的评估可作为肝癌预后的标志物,其Ⅳ级高风险提示预后不良。

Objective:To investigate the clinical value of BALAD-2 models in predcting prognosis in hepatocellular carcinoma(HCC)before treatment.Methods:A total of 125 HCC cases before treatment were collected from Fujian Cancer Hospital during December 2014 to March 2015,and their serum specimens were obtained.Serum level of DCP,AFP,and AFP-L3 were respectively measured via chemiluminescence immune assay,electrochemiluminescence and microcentrifuge analysis,and ALB and TBIL were analyzed so that to construct the BALAD-2 diagnostic model.All the clinical records of the HCC patients were collected and their survival time was traced.The risk index for progression-free survival and overall survival were calculated based on the BALAD-2 diagnostic model.All statistical analyses were conducted applied to SPSS16.0.Results:The risk ranking calculated based on BALAD-2 model were markedly linked to the status of HCC patients′HBV infection and liver cirrhosis,as well as tumor size and number,all with P<0.05.All the 125 HCC cases yielded a median progression-free survival(PFS)time of 3.2 months,3-year PFS rate of 9.6%,and the median overall survival(OS)time of 4.0 months,and 3-year OS rate of 16%.The survival time and survival rate were inversely related to the BALAD-2 model-based risk index before treatment.Stratified analysis showed that the patients with high risk BALAD-2 ranking(grade:Ⅳ)had a median PFS and OS of 2.0 and 2.6 months,respectively,and 3-year PFS and OS rates of both 16%,which were all significantly lower than the low risk group,all with P<0.05.The multi-factor regression analysis demonstrated that high risk BALAD-2 ranking and diameter>5 cm were estimated to be independent prognostic factors for the HCC cases before treatment,all with P<0.05.Conclusion:The BALAD-2 diagnostic model can be rated as a prognostic marker for HCC,and high risk BALAD-2 ranking(grade:Ⅳ)may indicate a poor prognosis for the HCC patients.