Xu Y, Wang P X, Cheng J W, Huang X W, Zhou J, Fan J, Yang X R
Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Zhonghua Gan Zang Bing Za Zhi. 2020 Nov 20;28(11):918-923. doi: 10.3760/cma.j.cn501113-20201009-00545.
To explore the clinical value of serum des-γ-carboxy prothrombin (DCP) in predicting hepatocellular carcinoma recurrence after liver transplantation. A total of 115 cases with hepatocellular carcinoma who underwent liver transplantation in Zhongshan Hospital Affiliated to Fudan University from October 2016 to December 2018 were retrospectively analyzed. Receiver operating characteristic curve analysis, Mann-Whitney U test, Kaplan-Meier method, Log-Rank test, χ2 test, univariate and multivariate Cox regression analysis and other statistical methods were used to explore the value of DCP in predicting tumor recurrence after liver transplantation and its correlation with clinicopathological characteristics. The preoperative serum DCP level in recurrent population after liver transplantation was significantly higher than that in non-recurrent population ( < 0.001). The optimal cut-off value of preoperative DCP for predicting recurrence was 200mAU/ml with the use of receiver operating characteristic curve. The sensitivity, specificity, Youden's index and the receiver operating characteristic curve was 87.90%, 57.30%, 0.452, and 0.726, respectively. Survival analysis results grouped by this cut-off value showed that patients with preoperative DCP ≥200mAU/ml had a higher probability of recurrence ( < 0.001). Further, subgroup survival analysis showed that patients with preoperative DCP≥200 mAU/ ml had a higher probability of recurrence than other cases of alpha-fetoprotein negative subgroup, cumulative tumor diameter ≤ 9 cm subgroup and Milan criteria subgroup ( < 0.05). Cox regression analysis showed that preoperative DCP≥200 mAU/ ml ( = 0.017) and cumulative tumor diameter > 9 cm ( = 0.014) was an independent risk factor for recurrence after liver transplantation. (2) test results showed that preoperative serum DCP level was correlated with gender, serum gamma glutamyltransferase level, serum alpha fetoprotein level, cumulative tumor diameter, vascular invasion, tumor differentiation and liver cancer transplant criteria ( < 0.05). Preoperative serum DCP can be used as a supplement to the existing liver cancer transplant criteria to predict hepatocellular carcinoma recurrence after liver transplantation. In addition, the accurate screening of patients with low risk of HCC recurrence after liver transplantation can improve the prognosis and efficacy of liver transplant patients.
探讨血清去γ-羧基凝血酶原（DCP）在预测肝移植后肝细胞癌复发中的临床价值。回顾性分析2016年10月至2018年12月在复旦大学附属中山医院接受肝移植的115例肝细胞癌患者。采用受试者工作特征曲线分析、Mann-Whitney U检验、Kaplan-Meier法、Log-Rank检验、χ2检验、单因素和多因素Cox回归分析等统计方法，探讨DCP在预测肝移植后肿瘤复发中的价值及其与临床病理特征的相关性。肝移植后复发人群术前血清DCP水平显著高于未复发人群（<0.001）。采用受试者工作特征曲线，术前DCP预测复发的最佳截断值为200mAU/ml。其灵敏度、特异度、约登指数和受试者工作特征曲线下面积分别为87.90%、57.30%、0.452和0.726。按此截断值分组的生存分析结果显示，术前DCP≥200mAU/ml的患者复发概率更高（<0.001）。进一步的亚组生存分析显示，术前DCP≥200mAU/ml的患者比甲胎蛋白阴性亚组、累积肿瘤直径≤9cm亚组和米兰标准亚组的其他病例复发概率更高（<0.05）。Cox回归分析显示，术前DCP≥200mAU/ml（=0.017）和累积肿瘤直径>9cm（=0.014）是肝移植后复发的独立危险因素。（2）检验结果显示，术前血清DCP水平与性别、血清γ-谷氨酰转移酶水平、血清甲胎蛋白水平、累积肿瘤直径、血管侵犯、肿瘤分化及肝癌移植标准相关（<0.05）。术前血清DCP可作为现有肝癌移植标准的补充，用于预测肝移植后肝细胞癌复发。此外，准确筛选肝移植后肝癌复发低风险患者可改善肝移植患者的预后和疗效。
