血清热休克蛋白90α对肝细胞癌经肝动脉化疗栓塞术后生存的预测价值

Influence of serum heat shock protein 90αon the prognosis of patients with hepatocellular carcinoma after transarterial chemoembolization

目的探讨术前血清热休克蛋白90α(HSP90α)水平对经肝动脉化疗栓塞术(TACE)治疗的肝细胞癌患者术后生存时间的影响。方法回顾性分析2019年1月1日—2020年6月1日于西南医科大学附属医院肝胆外科接受单一TACE治疗的97例肝细胞癌患者的临床资料。以患者血清HSP90α水平的中位数作为临界值,将入组病例分为高水平组(HSP90α>135 ng/L,n=48)和低水平组(HSP90α≤135 ng/L,n=49)。计数资料2组间的比较采用χ^(2)检验。采用Kaplan-Meier法计算中位生存时间,组间比较采用log-rank检验。通过log-rank单因素分析及Cox回归多因素分析探索患者术后生存时间的影响因素。结果血清HSP90α高水平组与低水平组患者的肝功能Child-Pugh分级(χ^(2)=19.356,P<0.01)、肿瘤坏死(χ^(2)=9.964,P=0.002)、BCLC分期(χ^(2)=22.356,P<0.01)及ECOG评分(χ^(2)=6.644,P<0.05)比较,差异均有统计学意义。HSP90α高水平组患者的中位生存时间比低水平组短,差异有统计学意义(χ^(2)=15.551,P<0.01);HSP90α水平(HR=1.690,P<0.05)及BCLC分期(HR=2.373,P<0.05)均是肝癌患者TACE术后生存时间的独立影响因素。结论术前血清HSP90α水平是影响肝癌患者TACE术后生存时间的独立因素,有望成为评估经TACE治疗肝癌患者预后的潜在指标之一。

Objective To investigate the influence of preoperative serum heat shock protein 90α(HSP90α)level on the survival time of patients with hepatocellular carcinoma treated by transarterial chemoembolization(TACE).Methods A retrospective analysis was performed for the clinical data of 97 patients with hepatocellular carcinoma who received TACE alone in Department of Hepatobiliary Surgery,The Affiliated Hospital of Southwest Medical University,from January 1,2019 to June 1,2020.With the median of serum HSP90αlevel as the cut-off value,the patients were divided into high-level group with 48 patients(HSP90α>135 ng/L)and low-level group with 49 patients(HSP90α≤135 ng/L).The chi-square test was used for comparison of categorical data between groups.The Kaplan-Meier method was used to calculate the median survival time,and the log-rank test was used for comparison between groups.The log-rank univariate analysis and multivariate Cox regression analysis were used to explore the influencing factors for the survival time of patients after surgery.Results There were significant differences between the high-level group and the low-level group in Child-Pugh class(χ^(2)=19.356,P<0.01),tumor necrosis(χ^(2)=9.964,P=0.002),BCLC staging(χ^(2)=22.356,P<0.01),and ECOG score(χ^(2)=6.644,P<0.05).The high-level group had a significantly shorter median survival time than the low-level group(χ^(2)=15.551,P<0.01).HSP90αlevel(hazard ratio[HR]=1.690,P<0.05)and BCLC staging(HR=2.373,P<0.05)were independent influencing factors for the survival time of patients with hepatocellular carcinoma after TACE.Conclusion Preoperative serum HSP90αlevel is an independent influencing factor for the survival time of patients with hepatocellular carcinoma after TACE,and it is expected to become one of the potential indicators for evaluating the prognosis of patients with hepatocellular carcinoma treated by TACE.