消融后去γ-羧基凝血酶原水平可预测乙型肝炎相关肝细胞癌的预后。
Post-ablation des-gamma-carboxy prothrombin level predicts prognosis in hepatitis B-related hepatocellular carcinoma.
机构信息
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
出版信息
Liver Int. 2016 Apr;36(4):580-7. doi: 10.1111/liv.12991. Epub 2015 Nov 18.
BACKGROUND & AIMS: We investigated whether pre- or post-ablation serum alpha-foetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP) levels can predict prognosis in patients with curative radiofrequency ablation (RFA) for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC).
METHODS
We retrospectively analysed 412 patients with HBV-related single HCC treated with percutaneous RFA between January 2004 and December 2013. AFP and DCP levels were measured before (pre-ablation) and 1 month after treatment (post-ablation). We assessed predictive factors for overall and recurrence-free survival.
RESULTS
On univariate analysis, Child-Pugh score, Model for End-Stage Liver Disease (MELD) score, platelet count, tumour size, Barcelona Clinic Liver Cancer (BCLC) stage, and pre- and post-ablation DCP were significant for overall survival; and age, Child-Pugh score, MELD score, platelet count, tumour size, Cancer of the Liver Italian Program (CLIP) score, BCLC stage, and pre- and post-ablation AFP and DCP were significant for recurrence-free survival. Multivariate analysis revealed significant differences in overall survival by MELD score and tumour size and in recurrence-free survival by BCLC stage. Among the tumour markers, post-ablation DCP was an independent prognostic factor for overall and recurrence-free survival [hazard ratio (HR), 3.438; 95% confidence interval (CI), 1.331-8.877; P = 0.011 and HR, 4.934; 95% CI, 2.761-8.816; P < 0.001 respectively]. Post-ablation AFP was associated with recurrence-free survival (HR, 1.995; 95% CI, 1.476-2.697; P < 0.001) but not overall survival.
CONCLUSIONS
In patients with HBV-related HCC, post-ablation serum DCP is a useful biomarker for predicting survival and recurrence after curative RFA.
背景与目的
本研究旨在探讨根治性射频消融（RFA）治疗乙型肝炎病毒（HBV）相关肝细胞癌（HCC）患者时，术前和术后血清甲胎蛋白（AFP）和脱γ-羧基凝血酶原（DCP）水平能否预测预后。
方法
本研究回顾性分析了 2004 年 1 月至 2013 年 12 月期间接受经皮 RFA 治疗的 412 例 HBV 相关单发 HCC 患者的临床资料。治疗前（消融前）和治疗后 1 个月（消融后）分别检测 AFP 和 DCP 水平。评估总生存期和无复发生存期的预测因素。
结果
单因素分析显示，Child-Pugh 评分、终末期肝病模型（MELD）评分、血小板计数、肿瘤大小、巴塞罗那临床肝癌（BCLC）分期、消融前和消融后 DCP 是总生存期的显著预测因素；年龄、Child-Pugh 评分、MELD 评分、血小板计数、肿瘤大小、意大利肝癌计划（CLIP）评分、BCLC 分期以及 AFP 和 DCP 的消融前和消融后水平是无复发生存期的显著预测因素。多因素分析显示，MELD 评分和肿瘤大小是总生存期的显著影响因素，BCLC 分期是无复发生存期的显著影响因素。在肿瘤标志物中，消融后 DCP 是总生存期和无复发生存期的独立预后因素[风险比（HR），3.438；95%置信区间（CI），1.331-8.877；P = 0.011 和 HR，4.934；95% CI，2.761-8.816；P < 0.001]。消融后 AFP 与无复发生存期相关（HR，1.995；95% CI，1.476-2.697；P < 0.001），但与总生存期无关。
结论
在 HBV 相关 HCC 患者中，RFA 治疗后血清 DCP 是预测根治性 RFA 后生存和复发的有用生物标志物。
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