Taher Mohamed Y, Hassouna Ehab, El Hadidi Abeer, El-Aassar Omar, Fathy Bakosh Mohamed, Said Shater Mohamed
Hepatobiliary Unit, Internal Medicine Department, Faculty of Medicine, Alexandria University, Egypt.
Clinical and Chemical Pathology, Faculty of Medicine, Alexandria University, Egypt.
J Clin Exp Hepatol. 2025 Jan-Feb;15(1):102405. doi: 10.1016/j.jceh.2024.102405. Epub 2024 Aug 17.
Cytokeratin 19 (CK19)-positive HCC is a subtype of hepatocellular carcinoma (HCC) with poor biological behavior and resistance to different treatments including transarterial chemoembolization (TACE). The current study aimed to investigate the predictive value of serum CK 19 fragment 21-1 (CYFRA 21-1) and serum CK 19 fragment 2G2 (CK 19-2G2) for TACE response in patients with hepatitis C virus (HCV)-related HCC.
This prospective study assessed the pretreatment serum CYFRA 21-1 and CK 19-2G2 levels in 64 patients with HCV-related naïve HCC who underwent TACE to predict 1-year overall survival (OS), progression-free survival (PFS), and objective response rate (ORR). Additionally, 40 healthy individuals were included as controls. Pretreatment alpha-fetoprotein (AFP) was also measured for comparison.
After exclusions, 60 patients completed TACE sessions, and the 1-year OS was 52%, and ORR post TACE was 71.8%. HCC patients with elevated levels of CYFRA 21-1, CK 19-2G2, or baseline AFP measuring ≥400 ng/ml have decreased 1-year OS and PFS after TACE. Serum CK19-2G2 was an independent predictor of 1-year OS using multivariate hazard regression analysis. Pretreatment normal serum CYFRA 21-1 levels ( = 0.047), serum AFP measuring <400 ng/ml ( = 0.016), and lower AST ( = 0.002) were independent predictors of ORR to TACE using multivariate logistic regression analysis. The predictive ability of pretreatment elevated serum CYFRA 21-1, AFP measuring ≥400 ng/ml, AFP + CYFRA 21-1, AFP + CK 19-2G2, or AFP + CYFRA 21-1+ CK19-2G2 to predict nonresponse (progressive disease) to TACE (area under the curve = 0.795, 0.690, 0.830, 0.725, and 0.850, respectively).
This study demonstrated that incorporating the measurement of serum CYFRA 21-1 or CK19-2G2 levels, along with AFP, during the initial diagnosis can aid in predicting poor 1-year OS, PFS, and ORR to TACE in patients with HCV-related HCC.
细胞角蛋白19（CK19）阳性肝癌是肝细胞癌（HCC）的一种亚型，具有不良生物学行为，且对包括经动脉化疗栓塞术（TACE）在内的不同治疗具有抗性。本研究旨在探讨血清CK 19片段21-1（CYFRA 21-1）和血清CK 19片段2G2（CK 19-2G2）对丙型肝炎病毒（HCV）相关肝癌患者TACE反应的预测价值。
这项前瞻性研究评估了64例接受TACE的HCV相关初治肝癌患者的治疗前血清CYFRA 21-1和CK 19-2G2水平，以预测1年总生存期（OS）、无进展生存期（PFS）和客观缓解率（ORR）。此外，纳入40名健康个体作为对照。还测量了治疗前甲胎蛋白（AFP）以作比较。
排除后，60例患者完成了TACE疗程，1年OS为52%，TACE术后ORR为71.8%。CYFRA 21-1、CK 19-2G2水平升高或基线AFP测量值≥400 ng/ml的HCC患者TACE术后1年OS和PFS降低。使用多因素风险回归分析，血清CK19-2G2是1年OS的独立预测因子。使用多因素逻辑回归分析，治疗前血清CYFRA 21-1水平正常（P = 0.047）、血清AFP测量值<400 ng/ml（P = 0.016）和较低的谷草转氨酶（P = 0.002）是TACE ORR的独立预测因子。治疗前血清CYFRA 21-1升高、AFP测量值≥400 ng/ml、AFP + CYFRA 21-1、AFP + CK 19-2G2或AFP + CYFRA 21-1 + CK19-2G2预测对TACE无反应（疾病进展）的能力（曲线下面积分别为0.795、0.690、0.830、0.725和0.850）。
本研究表明，在初始诊断时纳入血清CYFRA 21-1或CK19-2G2水平以及AFP的测量，有助于预测HCV相关肝癌患者1年OS、PFS不佳以及对TACE的ORR。
