原发性肝癌预后不良的危险因素及其预后预测价值分析

Analysis of risk factors and prognostic value of poor prognosis of hepatocellular carcinoma

目的分析原发性肝癌(HCC)预后不良的危险因素及其预后预测价值。方法回顾性分析2018年3月至2020年3月本院收治的100例HCC患者的临床资料,患者均采取肝动脉化疗栓塞治疗,行高尔基体蛋白73(GP73)、甲胎蛋白异质体-L3(AFP-L3)、甲胎蛋白(AFP)、α-L-岩藻糖苷酶(AFU)水平检测。分析患者术后1年预后情况,采用单因素、多因素Logistic回归分析HCC患者术后1年死亡的危险因素,绘制ROC曲线分析GP73、AFP-L3、AFP、AFU对HCC患者术后1年死亡的预测价值。结果100例HCC患者中,死亡15例,生存85例。死亡患者年龄≥60岁、微血管侵犯、淋巴结转移、无肿瘤包膜比例及GP73、AFP-L3、AFP、AFU水平均高于生存患者,差异有统计学意义(P<0.05);死亡与生存患者性别、病理分型比较差异无统计学意义。ROC曲线分析结果显示,GP73、AFP-L3、AFP、AFU预测HCC患者术后1年死亡的AUC分别为0.829、0.781、0.811、0.894,均具有一定预测价值。多因素Logistic回归分析结果显示,年龄≥60岁、微血管侵犯、淋巴结转移、无肿瘤包膜、GP73≥154.550μg/L、AFP-L3≥8.255%、AFP≥58.085μg/L、AFU≥40.335μg/L为HCC患者术后1年死亡的危险因素(OR>1,P<0.05)。结论高龄、微血管侵犯、淋巴结转移、无肿瘤包膜及GP73、AFP-L3、AFP、AFU高水平可能导致HCC患者术后预后不良,临床应根据上述因素制定相关预防措施,以改善患者预后。

Objective To analyze the risk factors and prognostic value of poor prognosis of hepatocellular carcinoma(HCC).Methods The clinical data of 100 patients with HCC admitted to our hospital from March 2018 to March 2020 were analyzed retrospectively,all patients were treat-ed with hepatic arterial chemoembolization,and the levels of Golgi protein 73(GP73),alpha-fetoprotein variant-L3(AFP-L3),alpha-fetoprotein(AFP)andα-L-fucosidase(AFU)were detected.The prognosis of patients at 1 year after surgery was analyzed,univariate and multivariate Logistic regression was used to analyze the risk factors of death in HCC patients at 1 year after surgery,and ROC curve was drawn to analyze the predictive value of GP73,AFP-L3,AFP and AFU for death in HCC patient at 1 year after surgery.Results Among 100 HCC patients,15 case of died and 85 case of survived.The proportion of age≥60 years old,microvascular invasion,lymph node metastasis,without tumor envelope and the levels of GP73,AFP-L3,AFP and AFU of the death patients were higher than those of survival patients,the differences were statistically significant(P<0.05);there was no significant difference in gender and pathological classification between death and survival patients.The ROC curve curve analy-sis results showed that the AUC of GP73,AFP-L3,AFP and AFU in predicting the death of HCC patients at 1 year after surgery were 0.829,0.781,0.811 and 0.894,respectively,which had certain predictive value.Multivariate Logistic regression analysis showed that age≥60 years old,microvas-cular invasion,lymph node metastasis,without tumor envelope,GP73≥154.550μg/L,AFP-L3≥8.255%,AFP≥58.085μg/L and AFU≥40.335μg/L were the risk factors for the death of HCC patients with 1 year after surgery(OR>1,P<0.05).Conclusion Older age,microvascular invasion,lymph node metastasis,without tumor envelope and high levels of GP73,AFP-L3,AFP and AFU may lead to poor postoperative prognosis of HCC patients after surgery,clinical preventive measures should be formulated according to the above factors to improve the prognosis of HCC patients.