GALAD模型在原发性肝细胞癌诊断和预后评估中的价值研究

Clinical Value of GALAD Model on Diagnosis and Prognosis of Primary Hepatocellular Carcinoma

目的探讨GALAD(Gender,Age,Lens culinaris agglutinin⁃reactive AFP,AFP,Des⁃γ⁃carboxy prothrombin)模型在原发性肝细胞癌(hepatocellular carcinoma,HCC)诊断和预后评估中的价值。方法选取2016年11月至2019年11月在海南省肿瘤医院接受根治性手术治疗的HCC患者98例为HCC组,选取同期在海南省肿瘤医院确诊的良性肝脏疾病(benign liver diseases,BLD)患者87例为BLD组,同期进行健康体检的健康者86例为对照组。检测所有研究对象血清甲胎蛋白(alpha⁃fetoprotein,AFP)、甲胎蛋白异质体L3(Lens culinaris agglutinin⁃reactive alpha⁃fetoprotein,AFP⁃L3)、异常凝血酶原(des⁃γ⁃carboxy prothrombin,DCP)水平,采用受试者工作特征曲线(receiver operating characteristic curve,ROC)分析单个血清标志物及GALAD模型对HCC的诊断效能,并分析GALAD模型在HCC患者手术预后中的评估价值。结果GALAD模型诊断HCC的ROC曲线下面积(area under curve,AUC)为0.958,高于单个血清标志物及联合检测的AUC,差异有统计学意义(P<0.05),当截断值为2.75时,GALAD模型诊断HCC的灵敏度、特异度和准确度分别为81.6%、93.6%和89.3%。Kaplan⁃Meier生存曲线结果显示,GALAD模型高水平组患者3年累积生存率为23.8%,中位生存时间为28.03个月,低于GALAD模型低水平组的49.8%和36.38个月,差异有统计学意义(χ^(2)=12.022,P=0.001),GALAD模型高水平组3年累积无进展生存率为7.2%,中位无进展生存时间为20.70个月,低于GALAD模型低水平组的46.0%和30.32个月,差异有统计学意义(χ^(2)=9.810,P=0.002)。结论GALAD模型用于HCC的诊断效能优于AFP、AFP⁃L3,DCP和三项联合,并对HCC患者手术预后具有一定评估价值。

Objective To explore the value of GALAD(Gender,Age,Lens culinaris agglutinin⁃reactive AFP,AFP,Des⁃γ⁃carboxy prothrombin)model in diagnosis and prognosis of primary hepatocellular carcinoma(HCC).Methods 98 patients with primary HCC who received radical operation from November 2016 to November 2019 in Hainan Cancer Hospital were enrolled into HCC group.At the same time,87 patients with benign liver disease(BLD)confirmed in our hospital were enrolled into BLD group,and 86 health examinees were enrolled into control group.The levels of serum alpha fetoprotein(AFP),alpha fetoprotein variants(AFP⁃L3)and des⁃γ⁃carboxy prothrombin(DCP)of all subjects were detected.The receiver operating characteristic curve(ROC)was used to analyze the diagnostic performance of single serological marker and GALAD model for HCC.The evaluation value of GALAD model in the surgical prognosis of HCC patients was analyzed.Results The area under ROC curve(AUC)of GALAD model was 0.958,higher than that of single serological marker and combined detection,the difference was statistically significant(P<0.05).When the cutoff value was 2.75,the sensitivity,specificity and accuracy were 81.6%,93.6%and 89.3%respectively.Kaplan⁃Meier survival curve analysis showed that the 3⁃year survival rate and median survival time of patients with high GALAD level were 23.8%and 28.03 months,distinctly lower than that of patients with low GALAD level,the 3⁃year survival rate and median survival time for the latter were 49.8%and 36.38 months(χ(2)=12.022,P=0.001).And the 3⁃year progression⁃free survival rate and median survival time of patients with high GALAD level were 7.2%and 20.70 months,distinctly lower than that of patients with low GALAD level,the 3⁃year progression⁃free survival rate and median survival time for the latter were 46.0%and 30.32 months(χ^(2)=9.810,P=0.002).Conclusions GALAD model has better diagnostic performance than AFP,AFP⁃L3,DCP and combined detection in HCC,and has certain value in evaluating the surgical prognosis.