晚期肝癌90例TACE联合调强放疗后血清甲胎蛋白-L3、高尔基蛋白73、淋巴细胞/单核细胞比值水平与预后的关系

Relationship between alpha-fetoprotein-L3,Golgi protein 73,and lymphocyte/monocyte ratio prognosis in 90 patients with advanced liver cancer after TACE combined with intensity-modulated radiotherapy

目的 探讨晚期肝癌病人肝动脉化疗栓塞术(TACE)联合调强放疗后血清甲胎蛋白-L3(AFP-L3)、高尔基蛋白73(GP73)、淋巴细胞/单核细胞比值(LMR)水平变化及与预后的关系。方法 选择2018年12月至2019年12月攀枝花市中心医院90例晚期肝癌行TACE联合调强放疗治疗病人作为病例组,根据1年后病人存活情况分为存活组与死亡组,比较两组AFP-L3、GP73及LMR水平变化,采用多因素logistic回归分析影响死亡的因素,采用ROC曲线分析不同指标对死亡的预测价值。结果90例晚期肝癌病人随访1年有26例病人死亡,死亡率为28.9%。治疗后3月、6月死亡组AFP-L3[(212.16±11.57)μg/L、(378.93±19.67)μg/L]、GP73[(179.90±6.37)μg/L、(246.24±14.06)μg/L]水平均高于存活组[(123.63±11.03)μg/L、(126.23±9.33)μg/L;(106.69±8.56)μg/L、(109.30±10.26)μg/L](P<0.05),而LMR[(3.96±0.48)%、(3.72±0.55)%]低于存活组[(4.19±0.41)%、(4.21±0.35)%](P<0.05)。COX回归显示:肿瘤长径、肝脏储备功能分级(Child-Pugh)(B级)、病灶数(多发)、AFP-L3、GP73是晚期肝癌病人死亡的危险因素(P<0.05),LMR是保护因素(P<0.05)。ROC分析显示:AFP-L3(治疗前)、GP73(治疗前)、LMR(治疗前)等三指标,均具有较高的对晚期肝癌病人死亡的预测评估价值,AUC均在0.7以上。而该三指标的联合应用:对晚期肝癌病人死亡的预测评估价值明显高于各指标单独应用,AUC(95%CI)为0.85(0.72~0.97),准确度高达0.84(76/90)。结论晚期肝癌病人TACE联合调强放疗后血清AFP-L3、GP73、LMR水平均有明显改善,治疗前AFP-L3、GP73越高,LMR越低的病人死亡风险越高,多项指标联合检测对预测死亡有较高的价值。

Objective cyte/monocyte ratio(LMR) levels in patients with advanced liver cancer after transcatheter arterial chemoembolization(TACE) combined with intensity-modulated radiotherapy and their correlation with prognosis.Methods A total of 90 patients with advanced liver cancer who received TACE combined with intensity-modulated radiotherapy in Panzhihua Central Hospital from December 2018 to December 2019 were selected as the case group,and the patients were divided into a survival group and a death group according to their survival after 1 year.The changes in AFP-L3,GP73 and LMR levels in the two groups were compared,the factors affecting death were analyzed by multivariate logistic regression,and the predictive values of different indicators on death were analyzed by ROC curve.Results Patients with advanced liver cancer were followed up for 1 year,and 26 of 90 patients died,with a mortality rate of 28.9%.The levels of AFP-L3 [(212.16 ± 11.57) μg/L,(378.93 ± 19.67) μg/L],and GP73 [(179.90 ± 6.37) μg/L,(246.24 ± 14.06) μg/L] in the death group at 3 and 6 months after treatment were higher than those in the survival group [(123.63 ± 11.03) μg/L,(126.23 ± 9.33) μg/L;(106.69 ± 8.56) μg/L,(09.30 ± 10.26) μg/L](P < 0.05),while the LMR [(3.96 ± 0.48)%,(3.72 ± 0.55)%] was lower than that in the survival group [(4.19 ± 0.41)%,(4.21±0.35)%](P < 0.05).Cox regression showed that tumor length,liver reserve function classification(Child-Pugh)(grade B),number of lesions(multiple),AFP-L3,and GP73 were risk factors for death in patients with advanced liver cancer(P < 0.05),while LMR was a protective factor(P < 0.05).ROC analysis showed that AFP-L3(before treatment),GP73(before treatment),and LMR(before treatment) all had high predictive and evaluation values for the death of patients with advanced liver cancer,and the AUC values were all above 0.7.The combined application of the three indicators has significantly higher value in predicting and evaluating the death of patients with advanced liver cancer than each indicator alone,with an AUC(95%CI) of 0.85(0.72-0.97) and an accuracy of 0.84(76/90).Conclusions vanced liver cancer after TACE combined with intensity-modulated radiotherapy.Patients with higher AFP-L3 and GP73 and lower LMR before treatment had a higher risk of death,and the combined detection of multiple indicators had higher value in predicting death.