Kohles Nikolaus, Nagel Dorothea, Jüngst Dietrich, Durner Jürgen, Stieber Petra, Holdenrieder Stefan
Institute of Clinical Chemistry, University-Hospital Munich-Grosshadern, Munich, Germany.
Tumour Biol. 2012 Feb;33(1):33-40. doi: 10.1007/s13277-011-0237-7. Epub 2011 Sep 20.
As transarterial chemoembolization (TACE) therapy is an effective locoregional treatment for patients with advanced liver cancer, prognostic biomarkers are highly needed for pretherapeutic stratification of patients to TACE therapy. Sera of 50 prospectively and consecutively included patients with hepatocellular carcinoma (HCC) undergoing TACE were taken before and 24 h after TACE application. Levels of liver-specific, tumor-related, and cell death biomarkers were analyzed and correlated with overall patient survival. The study was particularly focused on patients treated by TACE with palliative intention (N = 38). Sixteen of 38 patients died within 1 year after TACE, 22 were still alive. In univariate analysis, high levels of cytokeratin 19-fragments (CYFRA 21-1), alpha fetoprotein (AFP), and low choline esterase (CHE) levels measured before and 24 h after TACE were correlated with unfavorable outcome. Further high pretherapeutic lactate dehydrogenase (LDH), aspartate-aminotransferase, and bilirubin levels as well as high 24 h C-reactive protein values were associated with poor survival. In multivariate analysis of clinical and only pretherapeutic biomarkers, AFP, CHE, and LDH showed to be independent prognostic parameters. When additionally 24 h values were included, CHE (24 h) and AFP (24 h) were the strongest independent prognostic biomarkers with a slightly higher prognostic power (Akaike's information criterion 90.3 vs. 92.7). The combination of AFP, CHE, and LDH enables efficient pretherapeutic stratification of HCC patients in advanced tumor stage for TACE therapy.
由于经动脉化疗栓塞(TACE)疗法是晚期肝癌患者有效的局部区域治疗方法,因此非常需要预后生物标志物来对接受TACE治疗的患者进行治疗前分层。对50例接受TACE治疗的肝细胞癌(HCC)患者进行前瞻性连续纳入研究,在TACE治疗前和治疗后24小时采集血清。分析肝脏特异性、肿瘤相关和细胞死亡生物标志物的水平,并将其与患者的总生存期进行关联。该研究特别关注以姑息治疗为目的接受TACE治疗的患者(N = 38)。38例患者中有16例在TACE治疗后1年内死亡,22例仍存活。在单因素分析中,TACE治疗前和治疗后24小时测得的细胞角蛋白19片段(CYFRA 21-1)、甲胎蛋白(AFP)水平升高以及胆碱酯酶(CHE)水平降低与不良预后相关。此外,治疗前乳酸脱氢酶(LDH)、天冬氨酸转氨酶和胆红素水平升高以及24小时C反应蛋白值升高与生存率低相关。在对临床和仅治疗前生物标志物的多因素分析中,AFP、CHE和LDH显示为独立的预后参数。当额外纳入24小时的值时,CHE(24小时)和AFP(24小时)是最强的独立预后生物标志物,预后能力略高(赤池信息量准则90.3对92.7)。AFP、CHE和LDH的组合能够对晚期肿瘤阶段的HCC患者进行有效的TACE治疗前分层。