用于预测肝癌患者肝切除术后肝衰竭的 Mac-2 结合蛋白糖基化异构体的有用性。

Usefulness of Mac-2 Binding Protein Glycosylation Isomer for Prediction of Posthepatectomy Liver Failure in Patients With Hepatocellular Carcinoma.

机构信息

*Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan †Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.

出版信息

Ann Surg. 2017 Jun;265(6):1201-1208. doi: 10.1097/SLA.0000000000001836.

DOI:10.1097/SLA.0000000000001836

PMID:27355265

Abstract

OBJECTIVE

The aim of this study was to evaluate the usefulness of the Mac-2 binding protein glycosylation isomer (M2BPGi) for the prediction of posthepatectomy liver failure (PHLF) in hepatocellular carcinoma (HCC) patients.

SUMMARY BACKGROUND DATA

M2BPGi is a novel serum marker of liver fibrosis. The usefulness of M2BPGi for the prediction of PHLF has not been evaluated.

METHODS

Clinicopathological data were analyzed in 138 HCC patients who underwent liver resection between August 2011 and November 2014. PHLF was evaluated according to the definition of the International Study Group of Liver Surgery. Performance of preoperative parameters in predicting PHLF was determined using receiver operating characteristic (ROC) analysis.

RESULTS

Serum M2BPGi level correlated with the METAVIR fibrosis score. M2BPGi levels of hepatitis C virus (HCV)-positive patients were significantly higher than those of HCV-negative patients, even in the same fibrosis stage. PHLF ≥ Grade B developed in 19 patients (13.8%). The area under the ROC curve (AUROC) of M2BPGi for the prediction of PHLF ≥ Grade B was 0.71. In multivariate analysis, M2BPGi [odds ratio (OR): 2.08, 95% confidence interval (CI) 1.28-3.55], platelet count (OR: 0.39, 95% CI 0.18-0.80), and resection rate (OR: 2.71, 95% CI 1.46-5.40) were the significant factors associated with PHLF ≥ Grade B. The AUROC of the PHLF index defined by these factors was 0.81. Notably, in patients with HCV infection, the predictive ability of M2BPGi for PHLF (AUROC 0.85) was the best among the preoperative parameters.

CONCLUSIONS

M2BPGi is a useful predictor of PHLF, especially in patients with HCV infection.

摘要

目的

本研究旨在评估 Mac-2 结合蛋白糖基化异构体（M2BPGi）在预测肝细胞癌（HCC）患者肝切除术后肝衰竭（PHLF）中的作用。

背景资料概要

M2BPGi 是一种新型的肝纤维化血清标志物。M2BPGi 预测 PHLF 的作用尚未得到评估。

方法

分析 2011 年 8 月至 2014 年 11 月期间接受肝切除术的 138 例 HCC 患者的临床病理资料。根据国际肝脏外科研究组的定义评估 PHLF。采用受试者工作特征（ROC）分析确定术前参数预测 PHLF 的性能。

结果

血清 M2BPGi 水平与 METAVIR 纤维化评分相关。HCV 阳性患者的 M2BPGi 水平明显高于 HCV 阴性患者，即使在相同的纤维化阶段也是如此。19 例（13.8%）患者发生 PHLF≥Grade B。M2BPGi 预测 PHLF≥Grade B 的 ROC 曲线下面积（AUROC）为 0.71。多因素分析显示，M2BPGi[比值比（OR）：2.08，95%置信区间（CI）1.28-3.55]、血小板计数（OR：0.39，95%CI 0.18-0.80）和切除率（OR：2.71，95%CI 1.46-5.40）是与 PHLF≥Grade B 相关的显著因素。这些因素定义的 PHLF 指数的 AUROC 为 0.81。值得注意的是，在 HCV 感染患者中，M2BPGi 预测 PHLF 的能力（AUROC 为 0.85）是术前参数中最佳的。