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去γ-羧基凝血酶原在肝切除术后甲胎蛋白阴性肝细胞癌患者中的预后价值:

Prognostic Value of Des-Gamma-Carboxy Prothrombin in AFP-Negative Hepatocellular Carcinoma Patients Following Liver Resection: .

作者信息

Liu Si-Yu, Dai Mu-Gen, Lu Wen-Feng, Liang Lei, Liu Jun-Wei, Li Zhuo-Kai, Ye Bin

机构信息

School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China.

Department of Laboratory Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Zhejiang Province, China.

出版信息

J Cancer. 2025 Jun 12;16(8):2680-2689. doi: 10.7150/jca.112394. eCollection 2025.


DOI:10.7150/jca.112394
PMID:40535812
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12171001/
Abstract

Hepatocellular carcinoma (HCC) is a major global health concern with high postoperative recurrence rates. Des-gamma-carboxy prothrombin (DCP) is a promising biomarker for HCC prognosis, but its optimal cutoff value remains unclear, especially in AFP-negative patients. This study aimed to determine the ideal cutoff value of DCP in AFP-negative HCC patients following liver resection and to investigate its impact on long-term outcomes. This multicenter retrospective study included 661 patients who underwent curative HCC resection between 2015 and 2020 at three Chinese hospitals. Patients with AFP levels < 20 ng/mL were included. The primary endpoints were overall survival (OS) and time to recurrence (TTR). DCP levels were categorized as low (≤ 600 mAU/ml) and high (> 600 mAU/ml). Among the 661 patients (median age 56 years; 88.4% men), 477 had low DCP levels and 184 had high DCP levels. Patients with high DCP levels had more aggressive tumor characteristics, including larger tumor size, microvascular invasion, and macrovascular invasion. The 5-year OS rates were 76.3% in the low DCP group vs. 57.6% in the high DCP group ( < 0.001), and the 5-year recurrence rates were 44.9% vs. 61.0% ( < 0.001), respectively. Multivariable analysis showed that high DCP levels were an independent risk factor for decreased OS (HR 1.548, 95%CI 1.135-2.111; = 0.006) and increased TTR (HR 1.390, 95%CI 1.081-1.787; = 0.010). A DCP cutoff value of 600 mAU/ml effectively stratifies AFP-negative HCC patients into high- and low-risk groups for survival and recurrence after liver resection. This cutoff value can guide clinical decision-making and improve prognostic accuracy.

摘要

肝细胞癌(HCC)是一个全球性的重大健康问题,术后复发率很高。去γ-羧基凝血酶原(DCP)是一种很有前景的HCC预后生物标志物,但其最佳临界值仍不明确,尤其是在甲胎蛋白(AFP)阴性的患者中。本研究旨在确定肝切除术后AFP阴性HCC患者中DCP的理想临界值,并探讨其对长期预后的影响。这项多中心回顾性研究纳入了2015年至2020年间在中国三家医院接受根治性HCC切除术的661例患者。纳入AFP水平<20 ng/mL的患者。主要终点是总生存期(OS)和复发时间(TTR)。DCP水平分为低水平(≤600 mAU/ml)和高水平(>600 mAU/ml)。在这661例患者中(中位年龄56岁;88.4%为男性),477例DCP水平低,184例DCP水平高。DCP水平高的患者具有更具侵袭性的肿瘤特征,包括更大的肿瘤大小、微血管侵犯和大血管侵犯。低DCP组的5年总生存率为76.3%,而高DCP组为57.6%(<0.001),5年复发率分别为44.9%和61.0%(<0.001)。多变量分析显示,高DCP水平是OS降低(风险比[HR]1.548,95%置信区间[CI]1.135-2.111;P=0.006)和TTR增加(HR 1.390,95%CI 1.081-1.787;P=0.010)的独立危险因素。600 mAU/ml的DCP临界值可有效地将AFP阴性HCC患者分为肝切除术后生存和复发的高风险组和低风险组。该临界值可指导临床决策并提高预后准确性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/48c7/12171001/66f409ec5f5c/jcav16p2680g005.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/48c7/12171001/926c870d25be/jcav16p2680g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/48c7/12171001/66f409ec5f5c/jcav16p2680g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/48c7/12171001/4cc56e7b519d/jcav16p2680g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/48c7/12171001/c1686d90981b/jcav16p2680g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/48c7/12171001/7fbd98f1b0a1/jcav16p2680g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/48c7/12171001/926c870d25be/jcav16p2680g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/48c7/12171001/66f409ec5f5c/jcav16p2680g005.jpg

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本文引用的文献

[1]
Novel online calculator to predict reduced risk of early recurrence from adjuvant transarterial chemoembolisation for patients with hepatocellular carcinoma.

eGastroenterology. 2023-8-16

[2]
Opportunities and challenges for hepatitis B cure.

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[3]
Prognostic significance of postoperative serological incomplete conversion of AFP and PIVKA-II after hepatic resection for hepatocellular carcinoma: a multicenter analysis of 1755 patients.

Oncologist. 2024-12-6

[4]
Urgent Global Need for PIVKA-II and AFP-L3 Measurements for Surveillance and Management of Hepatocellular Carcinoma.

Liver Cancer. 2024-2-20

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Adjuvant and neoadjuvant immunotherapies in hepatocellular carcinoma.

Nat Rev Clin Oncol. 2024-4

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The Role of PIVKA-II as a Predictor of Early Hepatocellular Carcinoma Recurrence-Free Survival after Liver Transplantation in a Low Alpha-Fetoprotein Population.

Cancers (Basel). 2023-12-19

[7]
PIVKA-II combined with tumor burden score to predict long-term outcomes of AFP-negative hepatocellular carcinoma patients after liver resection.

Cancer Med. 2024-1

[8]
The association between alcohol consumption and the risk of hepatocellular carcinoma according to glycemic status in Korea: A nationwide population-based study.

PLoS Med. 2023-6

[9]
AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma.

Hepatology. 2023-12-1

[10]
Short Half-Life of Des-γ-Carboxy Prothrombin Is a Superior Factor for Early Prediction of Outcomes of Hepatocellular Carcinoma Treated with Radiofrequency Ablation.

Diagnostics (Basel). 2023-2-12

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