术前CA19-9联合FIB含量预测肝癌切除术后早期复发的临床意义

Clinical significance of preoperative CA19-9 combined with FIB levels in predicting early recurrence after liver resection for hepatocellular carcinoma

目的探讨糖类抗原19-9(CA19-9)联合纤维蛋白原(FIB)预测肝癌切除术后早期复发的临床意义。方法选取空军军医大学西京医院肝胆外科2020年6月至2021年6月收治的164例肝癌患者,手术切除后进行2年的随访,根据复发情况将患者分为早期复发组(n=71)和非早期复发组(n=93)。收集患者基线资料,比较两组术前CA19-9及FIB含量水平差异,采用多因素logistic回归分析寻找影响肝癌切除术后早期复发的因素,使用受试者工作特征(ROC)曲线评价术前CA19-9及FIB预测肝癌切除术后早期复发的效能。结果164例患者中肝切除术后早期复发71例(43.3%)。多因素logistic回归分析显示,巴塞罗那肝癌(BCLC)分期较晚、肿瘤未分化、术中输血、术前甲胎蛋白(AFP)>400 g/L、CA19-9>17.95 U/mL及FIB>2.73 g/mL(均P<0.05)是肝癌患者切除术后早期复发的独立危险因素。ROC曲线分析结果显示,CA19-9预测肝癌切除术后早期复发的ROC曲线下面积(AUC)、敏感度、特异度分别为0.793(95%CI:0.723~0.862)、0.662、0.817。FIB含量预测肝癌切除术后早期复发的AUC、敏感度、特异度分别为0.800(95%CI:0.734~0.866)、0.648、0.753。联合检测预测肝癌切除术后早期复发的AUC、敏感度、特异度分别为0.913(95%CI:0.869~0.958)、0.831、0.925。结论BCLC分期较晚、肿瘤未分化、术中输血、术前AFP>400 g/L、CA19-9>17.95 U/mL及FIB>2.73 g/mL与肝癌患者切除术后早期复发密切相关,CA19-9与FIB含量联合预测肝癌切除术后早期复发的价值较高。

Objective To investigate the clinical significance of carbohydrate antigen 19-9(CA19-9)combined with fibrinogen(FIB)in predicting early recurrence after liver resection for hepatocellular carcinoma.Methods A total of 164 patients with liver cancer admitted to Department of Hepatobiliary Surgery,Xijing Hospital,Air Force Medical University from June 2020 to June 2021 were selected for 2-year follow-up after surgical resection.According to the recurrence situation,the patients were divided into early recurrence(n=71)and non-early recurrence group(n=93).The baseline data of patients were collected,and the differences in preoperative CA19-9 and FIB levels between the two groups were compared.Multivariate logistic regression analysis was used to find the factors affecting the early recurrence after liver resection for hepatocellular carcinoma.Receiver operating characteristic(ROC)curve was used to evaluate the efficacy of preoperative CA19-9 and FIB in predicting early recurrence after liver resection for hepatocellular carcinoma.Results Among 164 patients,71(43.3%)had early recurrence after hepatectomy.Multivariate logistic regression analysis showed that advanced Barcelona Clinic Liver Cancer(BCLC)stage,tumor undifferentiation,intraoperative blood transfusion,preoperative AFP>400 g/L,CA19-9>17.95 U/mL,and FIB>2.73 g/mL(all P<0.05)were independent risk factors for early recurrence after liver resection for hepatocellular carcinoma.ROC curve analysis showed that the area under ROC curve(AUC),sensitivity,and specificity of CA19-9 in predicting early recurrence after liver resection for hepatocellular carcinoma were 0.793(95%CI:0.7230.862),0.662,and 0.817,respectively.The AUC,sensitivity,and specificity of FIB in predicting early recurrence after liver resection for hepatocellular carcinoma were 0.800(95%CI:0.7340.866),0.648,and 0.753,respectively.The AUC,sensitivity,and specificity of combined CA19-9 and FIB levels in predicting early recurrence after liver resection for hepatocellular carcinoma were 0.913(95%CI:0.8690.958),0.831,and 0.925,respectively.Conclusion Advanced BCLC stage,tumor undifferentiation,intraoperative blood transfusion,preoperative AFP>400 g/L,CA19-9>17.95 U/mL,and FIB>2.73 g/mL are closely related to early recurrence after liver resection for hepatocellular carcinoma.The combination of CA19-9 and FIB levels has a higher value in predicting early recurrence after liver resection for hepatocellular carcinoma.