Huang Wen-Yu, Zheng Sheng, Zhu Dan, Zeng Ying-Lang, Yang Juan, Zeng Xue-Li, Liu Pei, Zhang Shun-Ling, Yuan Ming, Wang Zhi-Xia
Department of Tumor and Vascular Interventional Therapy, Xiamen Humanity Hospital, Xiamen 361000, Fujian Province, China.
Department of Gastroenterology, The Third People's Hospital of Yunnan Province, Kunming 650011, Yunnan Province, China.
World J Gastrointest Surg. 2024 Sep 27;16(9):2860-2869. doi: 10.4240/wjgs.v16.i9.2860.
Changes in alkaline phosphatase (ALP) and γ-glutamyltransferase (GGT) levels in patients with primary liver cancer (PLC) after radiofrequency ablation (RFA). Hepatocellular carcinoma is a malignant tumor with high incidence worldwide. As a common local treatment, RFA has attracted much attention for its efficacy and influence on liver function.
To investigate the effect of serum ALP and GGT levels on the prognosis of patients with PLC treated by RFA.
The preoperative clinical data of 165 patients who were pathologically or clinically diagnosed with PLC and who received RFA in our hospital between October 2018 and June 2023 were collected. The chi-square test was used to compare the data between groups. The Kaplan-Meier method and Cox regression were used to analyze the associations between serum ALP and GGT levels and overall survival, progression-free survival (PFS) and clinical characteristics of patients before treatment.
The 1-year survival rates of patients with normal (≤ 135 U/L) and abnormal (> 135 U/L) serum ALP before treatment were 91% and 79%, respectively; the 2-year survival rates were 90% and 68%, respectively; and the 5-year survival rates were 35% and 18%, respectively. The difference between the two groups was statistically significant ( = 0.01). Before treatment, the 1-year survival rates of patients with normal serum GGT levels (≤ 45 U/L) and abnormal serum GGT levels (> 45 U/L) were 95% and 87%, the 2-year survival rates were 85% and 71%, and the 5-year survival rates were 37% and 21%, respectively. The difference between the two groups was statistically significant ( < 0.001). Serum ALP [hazard ratio (HR) = 1.766, 95% confidence interval (95%CI): 1.068-2.921, = 0.027] and GGT (HR = 2. 312, 95%CI: 1.367-3.912, = 0.002) is closely related to the overall survival of PLC patients after RF ablation and is an independent prognostic factor. The 1-year PFS rates were 72% and 50%, the 2-year PFS rates were 52% and 21%, and the 5-year PFS rates were 14% and 3%, respectively. The difference between the two groups was statistically significant ( < 0001). The 1-year PFS rates were 81% and 56% in patients with normal and abnormal serum GGT levels before treatment, respectively; the 2-year PFS rates were 62% and 35%, respectively; and the 5-year PFS rates were 18% and 7%, respectively, with statistical significance between the two groups ( < 0.001). The serum ALP concentration (HR = 1. 653, 95%CI: 1.001-2.729, = 0.049) and GGT (HR = 1.949, 95%CI: 1.296-2.930, = 0.001) was closely associated with PFS after RFA in patients with PLC. The proportion of male patients with abnormal ALP levels is high, the Child-Pugh grade of liver function is poor, and the incidence of ascites is high. Among GGT-abnormal patients, the Child-Pugh grade of liver function was poor, the tumor stage was late, the proportion of patients with tumors ≥ 5 cm was high, and the incidence of hepatic encephalopathy was high.
Serum ALP and GGT levels before treatment can be used to predict the prognosis of patients with PLC after RFA, and they have certain guiding significance for the long-term survival of patients with PLC after radiofrequency therapy.
原发性肝癌（PLC）患者经射频消融（RFA）后碱性磷酸酶（ALP）和γ-谷氨酰转移酶（GGT）水平的变化。肝细胞癌是一种在全球范围内发病率较高的恶性肿瘤。作为一种常见的局部治疗方法，RFA因其疗效及对肝功能的影响而备受关注。
探讨血清ALP和GGT水平对接受RFA治疗的PLC患者预后的影响。
收集2018年10月至2023年6月期间在我院接受RFA治疗、经病理或临床诊断为PLC的165例患者的术前临床资料。采用卡方检验比较组间数据。采用Kaplan-Meier法和Cox回归分析血清ALP和GGT水平与患者总生存、无进展生存（PFS）及治疗前临床特征之间的关联。
治疗前血清ALP正常（≤135 U/L）和异常（>135 U/L）的患者1年生存率分别为91%和79%；2年生存率分别为90%和68%；5年生存率分别为35%和18%。两组间差异具有统计学意义（P = 0.01）。治疗前血清GGT水平正常（≤45 U/L）和异常（>45 U/L）的患者1年生存率分别为95%和87%，2年生存率分别为85%和71%，5年生存率分别为37%和21%。两组间差异具有统计学意义（P < 0.001）。血清ALP[风险比（HR）= 1.766，95%置信区间（95%CI）：1.068 - 2.921，P = 0.027]和GGT（HR = 2.312，95%CI：1.367 - 3.912，P = 0.002）与RFA术后PLC患者的总生存密切相关，是独立的预后因素。1年PFS率分别为72%和50%，2年PFS率分别为52%和21%，5年PFS率分别为14%和3%。两组间差异具有统计学意义（P < 0.001）。治疗前血清GGT水平正常和异常的患者1年PFS率分别为81%和56%；2年PFS率分别为62%和35%；5年PFS率分别为18%和7%，两组间差异具有统计学意义（P < 0.001）。血清ALP浓度（HR = 1.653，95%CI：1.001 - 2.729，P = 0.049）和GGT（HR = 1.949, 95%CI：1.296 - 2.930，P = 0.001）与PLC患者RFA术后的PFS密切相关。ALP水平异常的男性患者比例较高，肝功能Child-Pugh分级较差，腹水发生率较高。在GGT异常的患者中，肝功能Child-Pugh分级较差，肿瘤分期较晚，肿瘤≥5 cm的患者比例较高，肝性脑病发生率较高。
治疗前血清ALP和GGT水平可用于预测PLC患者RFA术后的预后，对PLC患者射频治疗后的长期生存具有一定的指导意义。
