血清AFP、CA19-9、VEGF用于预测中晚期肝癌TACE疗效的价值探讨

The values of serum AFP,CA19-9 and VEGF in predicting the efficacy of TACE in advanced liver cancer

目的探讨血清甲胎蛋白(AFP)、糖类抗原19-9(CA19-9)、血管内皮生长因子(VEGF)用于预测中晚期肝癌肝动脉栓塞化疗术(TACE)疗效的价值。方法回顾性分析62例在亳州市人民医院采用TACE治疗的中晚期肝癌患者的临床资料,根据治疗后患者是否获益分为未获益组和获益组。统计患者未获益情况,比较未获益与获益患者TACE术前、术后次日空腹血清AFP、CA19-9、VEGF水平,采用Logistic回归分析中晚期肝癌TACE术后未获益的危险因素,并采用受试者工作特征(ROC)曲线分析各指标并对中晚期肝癌TACE疗效的预测价值。结果中晚期肝癌患者TACE术后的未获益率为40.32%;未获益患者TACE术前的血清AFP、CA19-9、VEGF水平与获益患者比较差异无统计学意义(P>0.05),术后次日未获益患者空腹的血清AFP、CA19-9、VEGF水平均高于获益患者(P<0.05);Logistic回归分析显示肿瘤直径≥5 cm、细胞低分化、TNM分期Ⅳ期、多个肿瘤术后次日与血清AFP、CA19-9、VEGF水平均是TACE术后未获益的危险因素(P<0.05);术后次日血清AFP、CA19-9、VEGF预测中晚期肝癌患者TACE术后未获益的cut-off值分别为431.00 ng/mL、31.65 U/mL、234.54 ng/mL,3项联合检测预测TACE术后未获益的灵敏度、特异度、曲线下面积(AUC)分别为96.00%、86.49%、0.890,AUC均高于单独预测,差异均有统计学意义(P<0.05)。结论中晚期肝癌患者TACE术后次日未获益患者的血清AFP、CA19-9、VEGF水平较高,与肿瘤直径≥5 cm等因素均为TACE术后患者未获益的危险因素。血清AFP、CA19-9、VEGF联合检测对中晚期肝癌患者TACE疗效的预测价值高,可用于指导治疗。

Objective To investigate the values of serum alpha-fetoprotein(AFP),carbohydrate antigen 19-9(CA19-9)and vascular endothelial growth factor(VEGF)levels in predicting the efficacy of hepatic arterial embolization chemotherapy(TACE)for advanced liver cancer.Methods The clinical data of 62 patients with advanced liver cancer treated with TACE in the hospital were retrospectively analyzed,and the patients were divided into the non-benefit group and the benefit group according to whether the patients benefited after treatment.The non-benefit rate of the patients was calculated,and the serum levels of AFP,CA19-9 and VEGF before TACE and the next day after TACE were compared between the benefit group and the non-benefit group.Logistic regression was used to analyze the risk factors of non-benefit after TACE for advanced liver cancer,and the predictive values of serum AFP,CA19-9 and VEGF on the efficacy of TACE in advanced liver cancer were analyzed.Results The non-benefit rates of patients with advanced liver cancer after TACE was 40.32%.Before TACE the serum AFP,CA19-9 and VEGF levels of the patients who did not benefit from TACE were not statistically different from the patients who benefited from TACE(P>0.05).The serum AFP,CA19-9 and VEGF levels of non-benefit group were all higher than those of the benefit group on the next day after TACE(P<0.05).Logistic regression analysis revealed that the tumor diameter≥5 cm,low cell differentiation,TNMⅣperiod,multiple tumors and serum AFP,CA19-9,VEGF levels on the next day after TACE were all risk factors for non-benefit after TACE(P<0.05).The cut-off values of serum AFP,CA19-9 and VEGF that predicted no benefit after TACE in patients with advanced liver cancer were 431.00 ng/mL,31.65 U/mL,234.54 ng/mL,respectively.The sensitivity,specificity and AUC of the three indicators combined predicting no benefit after TACE were 96.00%,86.49%and 0.890,respectively,and the AUC was higher than the 3 indicators used alone,and the differences were statistically significant(P<0.05).Conclusion The serum levels of AFP,CA19-9 and VEGF on next day after TACE in patients with advanced liver cancer who did not benefit from TACE treatment were relatively high,which are the risk factors for non-benefit after TACE,as well as tumor diameter≥5 cm and other factors.The combination of serum AFP,CA19-9 and VEGF has high predictive value for the efficacy of TACE in patients with advanced liver cancer,which could be used to guide the treatment.