异常凝血酶原Ⅱ在肝细胞癌患者经肝动脉化疗栓塞术后的预后价值

Value of PIVKA-Ⅱin Predicting Complete Response of Hepatocellular Carcinoma After Transarterial Chemoembolization

目的探索异常凝血酶原(PIVKA)-Ⅱ在预测肝细胞癌(HCC)经肝动脉化疗栓塞术(TACE)后完全缓解(CR)的价值。方法回顾性分析2016年1月至2018年1月于西部地区某医院收治的87例接受TACE治疗的HCC患者临床资料,包括患者TACE术前和术后血清PIVKA-Ⅱ水平,采用多变量分析预测患者病死率及TACE术后CR的独立预测因素。结果纳入HCC患者(中位年龄62岁,男性70%)巴塞罗那肝癌临床(BCLC)分期:A期(15%)、B期(85%),TACE术前中位PIVKA-Ⅱ值为172 mAU/mL,在中位随访20个月后,有52例(60%)患者死亡。PIVKA-Ⅱ水平与肿瘤负荷呈正相关(P<0.05),浸润性生长的HCC患者PIVKA-Ⅱ水平明显高于非浸润性生长的HCC患者。PIVKA-Ⅱ值(<24 mAU/mL)是影响TACE术后CR的独立预测因素。多因素回归分析显示,PIVKA-Ⅱ值与浸润性生长是HCC患者死亡的独立预测因素。结论PIVKA-Ⅱ可预测HCC患者TACE术后CR,且PIVKA-Ⅱ值与肿瘤浸润性生长可影响HCC患者TACE术后的生存期。

Objective To explore the value of protein induced by vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ)in predicting complete responses(CR)of hepatocellular carcinoma(HCC)after transarterial chemoembolization(TACE).Methods The clinical data of 87 HCC patients treated with TACE in General Hospital of Western Theater Command from January 2016 to January 2018 were retrospectively analyzed,including serum PIVKA-Ⅱlevels before and after TACE.Multivariable analysis was conducted to evaluate predictors of mortality and CR after TACE.Results Among the HCC patients included,the median age was 62 years old,and 70%of them were male.And of the Barcelona Clinic Liver Cancer(BCLC)staging,stage A accounted for 15%,and stage B accounted for 85%.Before TACE,the median PIVKA-Ⅱlevel was 172 mAU/mL.After a median follow-up of 20 months,52(60%)patients died.PIVKA-Ⅱlevel was positively correlated with tumor burden(P<0.05).Patients with invasive tumor had signifificantly higher PIVKA-Ⅱlevels than those with non-invasive tumor(P<0.05).Low PIVKA-Ⅱ(<24 mAU/mL)was an independent predictor of CR after TACE.Multivariable regression analysis indicated that PIVKA-Ⅱlevel and invasive tumor were independent predictors of death in HCC patients.Conclusion PIVKA-Ⅱis an independent predictor of CR after TACE.And PIVKA-Ⅱlevel combined with invasive tumor growth can affect the survival of HCC patients after TACE.