循环肿瘤DNA与原发性肝癌的临床相关性分析

Clinical correlation between circulating tumor DNA and hepatocellular carcinoma

目的分析循环肿瘤DNA(ctDNA)与原发性肝癌(PLC)的临床相关性,评估ctDNA对PLC的诊断和病情监测价值。方法检测PLC组(80例)、肝硬化组(30例)、慢性肝炎组(30例)患者及正常人群(正常组,30例)的外周血磷脂酰肌醇蛋白多糖3(GPC3)-ctDNA水平,比较各组ctDNA水平;采用受试者工作特征(ROC)曲线评估ctDNA对PLC的诊断效能;分析ctDNA浓度与PLC临床特征的相关性。结果PLC组患者的ctDNA水平明显高于其余3组(P<0.05)。ctDNA联合甲胎蛋白(AFP)诊断PLC的特异性(94%)和敏感性(80%)明显高于ctDNA单独诊断PLC的特异性(84%)和敏感性(63%)或AFP单独诊断PLC的特异性(73%)和敏感性(82%)。肿瘤最大直径>3 cm且伴门静脉癌栓者的ctDNA水平明显高于肿瘤直径≤3 cm且无门静脉癌栓者(P<0.05)。PLC巴塞罗那(BCLC)分期为进展期及终末期的患者ctDNA水平较早中期患者高(P<0.05)。结论ctDNA水平与PLC的发生发展具有临床相关性,联合AFP能够提高对PLC的诊断效能。

Objective To analyze the clinical correlation between circulating tumor DNA(ctDNA)and hepatocellular carcinoma(PLC),and the value of ctDNA in the diagnosis and monitoring of PLC.Methods The levels of glypican-3(GPC3)-ctDNA in peripheral blood of patients in PLC group(n=80),liver cirrhosis group(n=30),chronic hepatitis group(n=30)and normal people(n=30)were detected and compared.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic effect of ctDNA on PLC.The correlation between ctDNA and clinical characteristics of PLC was analyzed.Results The ctDNA level in PLC group was significantly higher than those in other three groups(P<0.05).The specificity(94%)and sensitivity(80%)of ctDNA combined alpha fetoprotein(AFP)in the diagnosis of PLC were significantly higher than those of ctDNA alone(specificity 84%,sensitivity 63%)and AFP alone(specificity 73%,sensitivity 82%).The ctDNA of patients with tumor diameter>3 cm and tumor thrombus was higher than that of patients with tumor diameter≤3 cm and without tumor thrombus(P<0.05).The ctDNA level of patients with advanced and end-stage of BCLC was higher in the early and middle stage(P<0.05).Conclusion ctDNA level is clinically correlated with the occurrence of PLC.Combined with AFP can improve the diagnosis of PLC.