肝细胞癌患者根治术前后PIVKA-Ⅱ、AFP变化及其临床意义

Changes of PIVKA-Ⅱ and AFP in Patients with Hepatocellular Carcinoma before and after Radical Resection and Their Clinical Significance

目的分析肝细胞癌(hepatocellular carcinoma,HCC)患者根治术前后血清异常凝血酶原(PIVKA-Ⅱ)、甲胎蛋白(AFP)变化及其临床意义。方法选取2016年1月~2019年5月徐州医科大学附属医院收治的首次行根治术的HCC患者154例,收集患者术前1周内及术后1个月左右血清PIVKA-Ⅱ、AFP水平并进行分析,分别计算PIVKA-Ⅱ、AFP术后与术前比值,根据比值绘制受试者工作特征(ROC)曲线,由最高约登指数确定截断点,分为高值组与低值组,比较两组复发率及无复发生存期(RFS),观察PIVKA-Ⅱ、AFP变化与复发之间的关系。结果154例患者中79例出现复发,复发组与未复发组PIVKA-Ⅱ及AFP水平比较,差异有统计学意义(P<0.05),两组术后PIVKA-Ⅱ、AFP均低于手术前(P<0.001)。高值组复发率高于低值组,RFS较短(P<0.001),PIVKA-Ⅱ比值用于诊断复发的ROC曲线下面积为0.807,AFP比值为0.747,二者联合为0.845,多因素分析提示,低分化、PIVKA-Ⅱ比值≥0.68、AFP比值≥0.53、PIVKA-Ⅱ比值+AFP比值≥0.55为RFS的独立危险因素。结论PIVKA-Ⅱ、AFP手术前后的变化与肿瘤复发相关,监测PIVKA-Ⅱ、AFP水平对评估患者预后具有重大参考价值。

Objective To analyze the changes of PIVKA-Ⅱand AFP before and after radical resection in patients with hepatocellular carcinoma and their clinical significance.Methods Totally 154 patients with hepatocellular carcinoma undergoing radical resection for the first time admitted to the Affiliated Hospital of Xuzhou Medical University from January 2016 to May 2019 were selected.The serum levels of PIVKA-Ⅱand AFP within 1 week before surgery and about 1 month after surgery were collected and analyzed.The receiver operating characteristic(ROC)curve according to the ratio was drew.The cut-off point by the highest Youden index was determined,and the patients were divide it into high value group and low value group by it.The recurrence rate and recurrence-free survival(RFS)of the two groups were observed.The relationship between the changes in indicators and recurrence was observed.Results Recurrence occurred in 79 of the 154 patients.Compared with the non-recurring group,the levels of PIVKA-Ⅱand AFP were significantly different between the recurrence group and the non-recurrence group(P<0.05).The PIVKA-Ⅱand AFP of the two groups after operation were lower than those before the operation(P<0.001).The recurrence rate of the high value group was higher than that of the low value group,the RFS was shorter(P<0.001).The area under the ROC curve of the PIVKA-Ⅱratio used to diagnose tumor recurrence was 0.807,the AFP ratio was 0.747,and the combination of the two was 0.845.The results of multivariate analysis showed that low differentiation,PIVKA-Ⅱratio≥0.68,AFP ratio≥0.53,PIVKA-Ⅱratio+AFP ratio≥0.55 were independent risk factors for RFS.Conclusion The changes before and after PIVKA-Ⅱand AFP surgery are related to tumor recurrence.Monitoring the levels of PIVKA-Ⅱand AFP is of great reference value for evaluating the prognosis of patients.