经动脉化疗栓塞治疗的中晚期肝细胞癌患者血清γ-谷氨酰转肽酶水平与总生存期的关系
Association of Serum ɣ-Glutamyl Transpeptidase Levels With Overall Survival in Intermediate and Advanced Hepatocellular Carcinoma Treated With Transarterial Chemoembolization.
作者信息
Patidar Yashwant, Meena Gaurav, Mukund Amar, Sharma Manoj K, Sarin Shiv K
机构信息
Department of Interventional Radiology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi-110070, India.
Department of Hepatology, Institute of Liver & Biliary Sciences, D-1 Vasant Kunj, New Delhi-110070, India.
出版信息
J Clin Exp Hepatol. 2023 Nov-Dec;13(6):934-945. doi: 10.1016/j.jceh.2023.04.009. Epub 2023 May 2.
INTRODUCTION
This article aims to evaluate the prognostic significance of pretreatment serum ɣ-glutamyl transpeptidase (GGT) levels in patients with intermediate (BCLC B) and advanced stage (BCLC C) hepatocellular carcinoma receiving transarterial chemoembolization (TACE) as first-line treatment.
METHODS
In this single-center retrospective study, a total of 608 patients with BCLC B and BCLC C class were included who received TACE as first-line treatment modality. Patients were divided into low and high GGT groups based on a cutoff value of pretreatment serum GGT levels calculated by receiver operating curve. Overall survival was evaluated with Kaplan-Meier method, and intergroup significance was calculated by log-rank test for overall patients, each BCLC B and BCLC C group. Univariate and multivariate analysis were used for significance for prognostic factors.
RESULTS
Median follow-up time was 20, 22, and 9 months for overall patients, BCLC B, and BCLC C group, respectively. Optimal cut value for GGT was calculated at 90.5 U/L. One-year and 3-year survival rates were 84.2% and 27.9% in low GGT, 49.4% and 8.6% in high-GGT group for overall patients. Multivariate analysis in overall patients showed Child-Pugh B (HR,1.801; 95%CI, 1.373-2.362, < .001), ascites (1.393, 1.070-1.812; = .014), multiple tumors (1.397, 1.137-1.716; = .001), AST >40 (1.407, 1.095-1.808; = .008), albumin <3.2 (.735, .612-.884; = .001), AFP > 400 (1.648, 1.351-2.011; < .001), high GGT (2.009, 1.631-2.475; < .001), or receipt of chemo/ablation (.463, .377-.569; < .001) as independent risk factors for overall survival. Serum GGT levels and AFP showed significant correlation in between with significance coefficient of .155 ( < .001).
CONCLUSION
Elevated pretreatment serum GGT level was feasible and promising independent prognostic marker for overall survival in intermediate and advanced stage hepatocellular carcinoma patients treated with TACE.
引言
本文旨在评估接受经动脉化疗栓塞术（TACE）作为一线治疗的中期（BCLC B期）和晚期（BCLC C期）肝细胞癌患者治疗前血清γ-谷氨酰转肽酶（GGT）水平的预后意义。
方法
在这项单中心回顾性研究中，共纳入608例接受TACE作为一线治疗方式的BCLC B期和BCLC C期患者。根据通过受试者工作曲线计算出的治疗前血清GGT水平临界值，将患者分为低GGT组和高GGT组。采用Kaplan-Meier法评估总生存期，并通过对数秩检验计算所有患者、各BCLC B期和BCLC C期组的组间显著性。采用单因素和多因素分析评估预后因素的显著性。
结果
所有患者、BCLC B期和BCLC C期组的中位随访时间分别为20个月、22个月和9个月。计算得出GGT的最佳临界值为90.5 U/L。所有患者中，低GGT组的1年和3年生存率分别为84.2%和27.9%，高GGT组分别为49.4%和8.6%。所有患者的多因素分析显示，Child-Pugh B级（HR，1.801；95%CI，1.373 - 2.362，P <.001）、腹水（1.393，1.070 - 1.812；P =.014）、多发肿瘤（1.397，1.137 - 1.716；P =.001）、AST>40（1.407，1.095 - 1.808；P =.008）、白蛋白<3.2（0.735，0.612 - 0.884；P =.001）、AFP>400（1.648，1.351 - 2.011；P <.001）、高GGT（2.009，1.631 - 2.475；P <.001）或接受化疗/消融治疗（0.463，0.377 - 0.569；P <.001）是总生存期的独立危险因素。血清GGT水平与AFP之间存在显著相关性，显著性系数为0.155（P <.
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