D-二聚体评估治疗反应和生存，以及药物洗脱微球经肝动脉化疗栓塞治疗肝细胞癌。

D-dimer for assessment of treatment response, and survival to drug-eluting beads transarterial chemoembolization in hepatocellular carcinoma.

机构信息

Department of Oncology Interventional Radiology, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshundong Road, Beijing 100015, China.

出版信息

Clin Res Hepatol Gastroenterol. 2023 Apr;47(4):102096. doi: 10.1016/j.clinre.2023.102096. Epub 2023 Feb 17.

DOI:10.1016/j.clinre.2023.102096

PMID:36801385

Abstract

BACKGROUND

D-dimer exhibits a certain prognostic value in hepatocellular carcinoma (HCC) patients who underwent hepatectomy and microwave ablation, while its value in estimating the clinical benefit of drug-eluting beads transarterial chemoembolization (DEB-TACE) remains unclear. Hence, this study aimed to investigate the correlation of D-dimer with tumor features, response and survival to DEB-TACE in HCC patients.

METHODS

Fifty-one HCC patients treated with DEB-TACE were recruited. Their serum samples at baseline and after DEB-TACE were collected and proposed for D-dimer detection by the immunoturbidimetry method.

RESULTS

Elevated D-dimer levels were related to a higher Child‒Pugh stage (P = 0.013), tumor nodule number (P = 0.031), largest tumor size (P = 0.004), and portal vein invasion (P = 0.050) in HCC patients. Then, patients were classified by the median value of D-dimer, and it was observed that patients with D-dimer >0.7 mg/L achieved a lower complete response rate (12.0% vs. 46.2%, P = 0.007) but a similar objective response rate (84.0% vs. 84.6%, P = 1.000) compared to those with D-dimer ≤0.7 mg/L. The Kaplan‒Meier curve showed that D-dimer >0.7 mg/L (vs. ≤0.7 mg/L) was related to shorter overall survival (OS) (P = 0.013). Further univariate Cox regression analyses showed that D-dimer >0.7 mg/L (vs. ≤0.7 mg/L) was related to unfavorable OS [hazard ratio (HR): 5.524, 95% confidence interval (CI): 1.209-25.229, P = 0.027], but it failed to independently estimate OS (HR: 10.303, 95%CI: 0.640-165.831, P = 0.100) in multivariate Cox regression analyses. Moreover, D-dimer was elevated during DEB-TACE therapy (P<0.001).

CONCLUSION

D-dimer may be helpful for monitoring prognosis to DEB-TACE therapy in HCC, while further large-scale-study validation is warranted.

摘要

背景

D-二聚体在接受肝切除术和微波消融治疗的肝细胞癌（HCC）患者中具有一定的预后价值，但其在评估载药微球动脉化疗栓塞（DEB-TACE）的临床获益中的价值尚不清楚。因此，本研究旨在探讨 D-二聚体与 HCC 患者 DEB-TACE 治疗的肿瘤特征、反应和生存之间的相关性。

方法

纳入 51 例接受 DEB-TACE 治疗的 HCC 患者。采集基线和 DEB-TACE 后患者的血清样本，采用免疫比浊法检测 D-二聚体。

结果

升高的 D-二聚体水平与较高的 Child-Pugh 分期（P=0.013）、肿瘤结节数量（P=0.031）、最大肿瘤大小（P=0.004）和门静脉侵犯（P=0.050）有关。然后，根据 D-二聚体的中位数将患者进行分类，结果发现 D-二聚体＞0.7mg/L 的患者完全缓解率较低（12.0%比 46.2%，P=0.007），但客观缓解率相似（84.0%比 84.6%，P=1.000）。Kaplan-Meier 曲线显示，D-二聚体＞0.7mg/L（比≤0.7mg/L）与总生存期（OS）较短相关（P=0.013）。进一步的单因素 Cox 回归分析显示，D-二聚体＞0.7mg/L（比≤0.7mg/L）与不良 OS 相关[风险比（HR）：5.524，95%置信区间（CI）：1.209-25.229，P=0.027]，但在多因素 Cox 回归分析中不能独立预测 OS（HR：10.303，95%CI：0.640-165.831，P=0.100）。此外，D-二聚体在 DEB-TACE 治疗期间升高（P＜0.001）。