术前Ki-67、γ-GT水平对原发性肝癌患者TACE治疗后生存期的影响

Effects of Preoperative Ki-67 andγ-GT Levels on Survival after TACE in Patients with Primary Hepatocellular Carcinoma

目的探讨术前Ki-67、γ-谷氨酰转肽酶(γ-GT)水平对原发性肝癌(HCC)患者肝动脉化疗栓塞术(TACE)治疗后生存期的影响。方法回顾性选取60例HCC根治术后行预防性TACE治疗患者作为研究对象。2年随访,分析患者TACE术前Ki-67、γ-GT不同表达水平与2年生存率之间的关系。结果经检测,60例HCC患者中Ki-67阳性细胞占比为(20.39±5.42)%,血清中γ-GT平均水平为(86.23±21.57)U/l。将Ki-67阳性细胞占比≤20%的25例患者作为低表达组,>20%的35例患者为高表达组;血清γ-GT≥50 U/l的38例患者为高表达组,<50 U/l的22例患者为低表达组。经2年随访,60例HCC患者2年总生存率56.67%,其中Ki-67高表达组2年生存率明显低于Ki-67低表达组(P<0.05),γ-GT高表达组2年生存率明显低于γ-GT低表达组(P<0.05)。单因素生存分析结果显示,HCC患者TACE治疗后的2年生存率与患者肿瘤直径、肿瘤包膜完整性、Ki-67表达、γ-GT表达和有无微血管癌栓明显相关(P<0.05);多因素Cox模型分析结果显示,Ki-67表达≥20%、γ-GT表达≥50 U/l和有微血管癌栓是影响HCC患者预防性TACE治疗后预后的独立因素(P<0.05)。结论术前Ki-67、γ-GT表达量与HCC患者预防性TACE治疗后的2年生存率密切相关,TACE术前Ki-67、γ-GT高表达可导致患者预后不良,二者可能可以作为预测HCC患者TACE术后不良预后的分子标志物。

Objective To explore the effects of preoperative Ki-67 andγ-glutamyl transpeptidase(γ-GT)levels on survival after transcatheter arterial chemoembolization(TACE)in patients with primary hepatocellular carcinoma(HCC).MethodsA total of 60 patients who underwent prophylactic TACE after HCC radical surgery were enrolled as the research objects.All were followed up for 2 years.The relationship between the different expression levels of Ki-67 andγ-GT before TACE and 2-year survival rate was analyzed.Results After testing,in the 60 HCC patients,proportion of positive Ki-67 cells and average level of serumγ-GT were(20.39±5.42)%and(86.23±21.57)U/l,respectively.There were 25 patients with proportion of positive Ki-67 cells not higher than 2025%(low-expression group)and 35 patients higher than 20%(high-expression group).There were 38 patients with serumγ-GT not lower than 50 U/l(high-expression group)and 22 patients lower than 50 U/l(low-expression group).After 2 years of follow-up,the 2-year overall survival rate in the 60 HCC patients was 56.67%.The 2-year survival rate in Ki-67 high-expression group was significantly lower than that in Ki-67 low-expression group(P<0.05),which was significantly lower inγ-GT high-expression group thanγ-GT low-expression group(P<0.05).The results of univariate survival analysis showed that 2-year survival rate of HCC patients after TACE was significantly related to tumor diameter,integrity of tumor envelope,expression of Ki-67 andγ-GT,and presence or absence of microvascular cancer thrombi(P<0.05).The results of multivariate Cox model analysis showed that Ki-67 not lower than 20%,γ-GT not lower than 50U/L and microvascular cancer thrombi were independent influencing factors of prognosis in HCC patients after prophylactic TACE(P<0.05).Conclusion The preoperative expression levels of Ki-67 andγ-GT are closely related to the 2-year survival rate in HCC patients after prophylactic TACE.High expression of Ki-67 andγ-GT before TACE can lead to poor prognosis,which can be applied as molecular markers of predicting poor prognosis.