Kishi K, Sonomura T, Mitsuzane K, Nishida N, Kimura M, Satoh M, Yamada R, Kodama N, Kinoshita M, Tanaka H
Department of Radiology, Saiseikai Wakayama Hospital, Wakayama, Japan.
Radiat Med. 1992 Sep-Oct;10(5):189-95.
We examined 35 untreated patients with unresectable hepatocellular carcinoma who exhibited positivity for both plasma PIVKA-II and serum AFP, and studied the weekly course of these markers from the pre-TAE or -HAI period to the third week of treatment. We correlated changes in these markers with the tumor necrosis rate and the time course on X-ray CT images. One week after TAE, the tumor necrosis rate and the time course of PIVKA-II showed a significant correlation (r = 0.7), while the correlation was between the time course of AFP and the tumor necrosis rate was insignificant (r = 0.2). At two and three weeks after TAE, both the time course of AFP and PIVKA-II showed significant correlations with the tumor necrosis rate. In 16 patients with tumor necrosis rates of not less than 90%, the mean of the actual half-life (AHL) of PIVKA-II was 3.2 days, the shortest was 1.83 days, and 75% of all AHLs clustered from two days to four days, while the mean and shortest AHLs of AFP were six days and 2.98 days, respectively, exhibiting a broader distribution. On the other hand, in three out of the nine cases of hepatocellular carcinoma complicated with portal tumor thrombi, PIVKA-II increased after HAI in spite of a reduction in tumor size. It was suggested that the PIVKA-II level requires careful interpretation in cases of portal vein obstruction after intensive hepatic arterial infusion of anticancer agents.
我们对35例未经治疗的不可切除肝细胞癌患者进行了检查，这些患者血浆异常凝血酶原（PIVKA-II）和血清甲胎蛋白（AFP）均呈阳性，并研究了这些标志物从经肝动脉化疗栓塞术（TAE）或肝动脉灌注化疗（HAI）术前阶段至治疗第三周的每周变化过程。我们将这些标志物的变化与肿瘤坏死率以及X线计算机断层扫描（CT）图像上的时间进程进行了关联分析。TAE术后一周，肿瘤坏死率与PIVKA-II的时间进程显示出显著相关性（r = 0.7），而AFP的时间进程与肿瘤坏死率之间的相关性不显著（r = 0.2）。TAE术后两周和三周，AFP和PIVKA-II的时间进程均与肿瘤坏死率显示出显著相关性。在16例肿瘤坏死率不低于90%的患者中，PIVKA-II的实际半衰期（AHL）平均值为3.2天，最短为1.83天，所有AHL中有75%集中在两天至四天之间，而AFP的AHL平均值和最短值分别为6天和2.98天，分布范围更广。另一方面，在9例合并门静脉癌栓的肝细胞癌患者中，有3例在HAI术后尽管肿瘤体积缩小，但PIVKA-II仍升高。提示在经肝动脉密集灌注抗癌药物后出现门静脉梗阻的情况下，对PIVKA-II水平需要谨慎解读。
