血清异常凝血酶原在中晚期肝癌患者中的表达及预后

Expression of serum PIVKA-Ⅱ in advanced hepatocellular carcinoma and its relationship with prognosis

目的探讨血清异常凝血酶原(PIVKA-Ⅱ)在中晚期肝细胞癌(HCC)患者血清中的表达及与临床病理特征和预后的关系。方法采用化学发光法分别对105例中晚期HCC患者、93例良性肝病患者、90例健康人的血清PIVKA-Ⅱ、AFP水平进行检测;Kaplan-Meier法绘制生存曲线,Log-rank检验进行生存差异比较;单因素、多因素Cox比例风险回归模型分析影响患者预后的独立危险因素;ROC曲线分析血清PIVKA-Ⅱ、AFP的诊断效能。结果中晚期肝癌组血清PIVKA-Ⅱ和AFP水平显著高于良性肝病组和对照组(均P <0.05);血清PIVKA-Ⅱ高表达与肿瘤大小、肿瘤数目、血管侵犯和TNM分期有关(均P <0.05);低表达组5年总体生存期(OS)和5年无进展生存期(PFS)显著高于高表达组(均P <0.05);多因素分析显示血清PIVKA-Ⅱ表达是影响中晚期肝癌患者5年OS、PFS的独立危险因素(均P <0.05);ROC曲线分析显示PIVKA-Ⅱ和AFP联合检测可显著提高诊断效能。结论 PIVKA-Ⅱ在中晚期肝癌患者血清中表达上调,其高表达与多种不良临床病理特征及预后密切相关,可作为判断中晚期肝癌患者预后的重要生物标志物。

Objective To explore the expression of serum protein induced by vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ)in advanced hepatocellular carcinoma(HCC)and its relationship with clinicopathological characteristics and prognosis. Methods Chemiluminescence method was used to detect serum PIVKA-Ⅱ and AFP levels in105 patients with advanced HCC,93 patients with benign hepatic diseases,and 90 healthy volunteers;survival analysis was performed by Kaplan-Meier method and Log-rank test;univariate and multivariate analysis were performed using the Cox proportional hazard analysis;the receiver operating characteristic(ROC)curve was used to analyze the efficacy of serum PIVKA-Ⅱ and AFP in diagnosing of advanced HCC. Results The expression levels of PIVKA-Ⅱ and AFP in advanced HCC group were significantly higher than those in benign hepatic diseases and control group(P < 0.05);the high-expression of PIVKA-Ⅱ in advanced HCC patients were correlated with the tumor size,tumor number,vascular invasion and TNM stag(P < 0.05);the 5-year OS and PFS in low-expression group were significantly better than those in high-expression group(P < 0.05);PIVKA-Ⅱ high-expression was independent risk factors affecting 5-year OS and PFS in advanced HCC patients(P < 0.05);the AUC of the combined detection of the two in the diagnosis of HCC is significantly higher than that of single detection(P <0.05). Conclusion PIVKA-Ⅱ was up-regulated in advanced HCC patients and its high-expression was closely related with several unfavorable clinicopathological features and prognosis,and it might be an important biomarker for predicting the prognosis of advanced HCC.