肝细胞癌患者微波消融治疗前后血清异常凝血酶原水平变化及临床意义

孙玉; 张洪海; 袁春旺; 李聪; 扈彩霞; 崔石昌; 张永宏; 郑加生

doi:10.3969/j.issn.1001-5256.2019.03.018

肝细胞癌患者微波消融治疗前后血清异常凝血酶原水平变化及临床意义

DOI: 10.3969/j.issn.1001-5256.2019.03.018

首都医科大学附属北京佑安医院肿瘤微创介入中心

基金项目:

国家自然科学基金资助项目(81472328)；

详细信息

中图分类号: R735.7
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出版历程
- 收稿日期: 2018-10-08
- 出版日期: 2019-03-20

Change in serum level of abnormal prothrombin after microwave ablation for hepatocellular carcinoma and its clinical significance

Minimally Invasive Interventional Center of Oncology, Beijing YouAn Hospital, Capital Medical University

Research funding:

摘要

摘要: 目的研究肝细胞癌（HCC）患者微波消融治疗前后血清异常凝血酶原（DCP）及AFP水平变化,并对HCC复发进行监测,探讨血清DCP、AFP水平与复发的关系。方法选择2015年12月-2018年2月在首都医科大学附属北京佑安医院住院治疗并经肝穿刺活组织病理检查确诊为HCC的患者76例,检测患者微波消融术前、术后、复发时血清DCP及AFP水平并进行分析。非正态分布的计量资料2组之间比较采用Mann-Whitney U检验,3组之间比较采用Kruskal-Wallis H检验; 2组样本的相关性检验采用Spearman相关分析。结果 HCC患者微波消融术后1周血清DCP及AFP与术前相比明显下降（Z值分别为6. 854、6. 246,P值均<0. 01）,术后1个月血清DCP及AFP相比术前及术后1周进一步下降,差异均有统计学意义（DCP:Z值分别为11. 639、4. 786,AFP:Z值分别为10. 058、3. 812,P值均<0. 01）。76例HCC患者中59例出现肿瘤复发,复发时其血清DCP及AFP水平均高于术后1周及术后1个月,差异均有统计学意义（DCP:Z值分别为-...
- 癌,肝细胞 /
- 导管消融术 /
- 甲胎蛋白类 /
- 异常凝血酶原
Abstract: Objective To investigate the changes in serum levels of des-γ-carboxy-prothrombin ( DCP) and alpha-fetoprotein ( AFP) after microwave ablation in patients with hepatocellular carcinoma ( HCC) , to monitor the recurrence of HCC, and to investigate the associa-tion of serum DCP and AFP levels with the recurrence of HCC. Methods A total of 76 patients who were hospitalized and treated in BeijingYouAn Hospital, Capital Medical University, from December 2015 to February 2018 and were diagnosed with HCC by liver biopsy were en-rolled. The serum levels of DCP and AFP were measured before and after microwave ablation and at the time of recurrence. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups, and the Kruskal-Wallis H testwas used for comparison between three groups; the Spearman correlation analysis was used to investigate correlation. Results At 1 week af-ter microwave ablation, the HCC patients had significant reductions in the serum levels of DCP and AFP ( Z = 6. 854 and 6. 246, both P <0. 01) , which further decreased at 1 month after microwave ablation ( DCP: Z = 11. 639 and 4. 786, both P < 0. 01; AFP: Z = 10. 058 and3. 812, both P < 0. 01) . Of all 76 HCC patients, 59 experienced recurrence, and the serum levels of DCP and AFP at the time of recurrencewere significantly higher than the levels at 1 week and 1 month after microwave ablation ( DCP: Z =-4. 671 and-8. 521, both P < 0. 01;AFP: Z =-3. 423 and-6. 311, both P < 0. 01) . Before microwave ablation, the recurrence group had significantly higher serum levels ofDCP and AFP than the non-recurrence group ( Z =-3. 010 and-2. 387, P = 0. 003 or P = 0. 017) ; at 1 month after microwave ablation, the recurrence group had a significantly higher serum level of DCP than the non-recurrence group ( Z =-3. 498, P < 0. 001) . In the re-currence group, the patients with extrahepatic distant metastasis or vascular invasion had a significantly higher serum level of DCP than thosewith intrahepatic recurrence alone before and at 1 month after microwave ablation ( χ2= 23. 597 and 18. 228, both P < 0. 01) . Correlation a-nalysis showed that in HCC patients with recurrence, serum DCP level before and at 1 month after microwave ablation was negatively correlated with time to recurrence ( r =-0. 500 and-0. 651, both P < 0. 01) . Conclusion Monitoring of serum DCP level before and after microwave ablation in HCC patients helps to judge the clinical effect of microwave ablation and predict recurrence and prognosis.
- carcinoma, hepatocellular /
- catheter ablation /
- alpha-fetoproteins /
- des-γ-carboxy-prothrombin

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参考文献(22)

[1] BRAY F, FERLAY J, SOERJOMATARAM I, et al. Global Canc-er Statistics 2018:Globocan estimates of incidence and mor-tality worldwide for 36 cancers in 185 countries[J]. CA CancerJ Clin, 2018, 68 (6) :394-424.

[2] ZHANG M, GAO Z, TAN GF, et al. Effect of transcatheter ar-terial chemoembolization combined with ultrasound-guidedmicrowave ablation in the treatment of primary hepatocellular-carcinoma[J]. China Med Herald, 2017, 14 (29) :103-106. (in Chinese) 张猛, 高众, 谭贵芳, 等.肝动脉化疗栓塞联合超声引导下微波消融治疗原发性肝癌的效果分析[J].中国医药导报, 2017, 14 (29) :103-106.

[3] LI D, KANG J, MADOFF DC. Locally ablative therapies for pri-mary and metastatic liver cancer[J]. Expert Rev Anticancer T-her, 2014, 14 (8) :931-945.

[4] HU CX, ZHENG JS, LIN W, et al. Analysis of risk factors forearly recurrence after microwave ablation for primary hepato-cellular carcinoma[J]. J Clin Hepatol, 2015, 31 (2) :228-231. (in Chinese) 扈彩霞, 郑加生, 林伟, 等.原发性肝癌微波消融术后早期复发危险因素分析[J].临床肝胆病杂志, 2015, 31 (2) :228-231.

[5] FUJIKAWA T, SHIRAHA H, YAMAMOTO K. Significance ofdes-gamma-carboxy prothrombin production in hepatocel-lular carcinoma[J]. Acta Med Okayama, 2009, 63 (6) :299-304.

[6] National Health and Family Planning Commission of the People'sRepublic of China. Diagnosis, management, and treatment ofhepatocellular carcinoma (V2017) [J]. J Clin Hepatol, 2017, 33 (8) :1419-1431. (in Chinese) 中华人民共和国国家卫生和计划生育委员会.原发性肝癌诊疗规范 (2017年版) [J].临床肝胆病杂志, 2017, 33 (8) :1419-1431.

[7] LU NN, ZHANG YH, WANG HY, et al. Value of serum alpha-fetoprotein and protein induced by vitamin K absence or an-tagonist-II in pathological diagnosis of hepatocellular carcino-ma[J]. J Clin Hepatol, 2017, 33 (11) :2162-2165. (in Chi-nese) 鹿宁宁, 张英华, 王海燕, 等.血清甲胎蛋白联合维生素K缺乏或拮抗剂Ⅱ诱导蛋白在肝细胞癌病理诊断中的应用价值[J].临床肝胆病杂志, 2017, 33 (11) :2162-2165.

[8] PARK H, PARK JY. Clinical significance of AFP and PIVKA-IIresponses for monitoring treatment outcomes and predictingprognosis in patients with hepatocellular carcinoma[J]. Bi-omed Res Int, 2013:310427.

[9] KIM DY, PAIK YH, AHN SH, et al. PIVKA-II is a useful tumormarker for recurrent hepatocellular carcinoma after surgical re-section[J]. Oncology, 2007, 72 (Suppl 1) :52-57.

[10] N'KONTCHOU G, MAHAMOUDI A, AOUT M, et al. Radiofre-quency ablation of hepatocellular carcinoma:Long-term re-sults and prognostic factors in 235 western patients with cirrho-sis[J]. Hepatology, 2009, 50 (5) :1475-1483.

[11] TOYODA H, KUMADA T, KANEOKA Y, et al. Prognostic val-ue of pretreatment levels of tumor markers for hepatocellularcarcinoma on survival after curative treatment of patients withHCC[J]. J Hepatol, 2008, 49 (2) :223-232.

[12] KOBAYASHI M, IKEDA K, KAWAMURA Y, et al. High serumdes-gamma-carboxy prothrombin level predicts poor prog-nosis after radiofrequency ablation of hepatocellular carcinoma[J]. Cancer, 2009, 115 (3) :571-580.

[13] TAKAHASHI S, KUDO M, CHUNG H, et al. PIVKA-II is thebest prognostic predictor in patients with hepatocellular carci-noma after radiofrequency ablation therapy[J]. Oncology, 2008, 75 (Suppl 1) :91-98.

[14] LEE S, RHIM H, KIM YS, et al. Post-ablation des-gamma-carboxy prothrombin level predicts prognosis in hepatitis B-related hepatocellular carcinoma[J]. Liver Int, 2016, 36 (4) :580-587.

[15] HONG YM, CHO M, YOON KT, et al. Risk factors of early re-currence after curative hepatectomy in hepatocellular carcino-ma[J]. Tumour Biol, 2017, 39 (10) :1010428317720863.

[16] CHON YE, CHOI GH, LEE MH, et al. Combined measure-ment of preoperativeα-fetoprotein and des-γ-carboxyprothrombin predicts recurrence after curative resection in pa-tients with hepatitis-B-related hepatocellular carcinoma[J].Int J Cancer, 2012, 131 (10) :2332-2341.

[17] NANASHIMA A, SUMIDA Y, TOBINAGA S, et al. Postopera-tive changes in protein-induced vitamin K absence or antago-nist II levels after hepatectomy in patients with hepatocellularcarcinoma:Relationship to prognosis[J]. HPB (Oxford) , 2006, 8 (2) :137-141.

[18] KANDA M, TATEISHI R, YOSHIDA H, et al. Extrahepatic me-tastasis of hepatocellular carcinoma:Incidence and risk fac-tors[J]. Liver Int, 2008, 28 (9) :1256-1263.

[19] BAE HM, LEE JH, YOON JH, et al. Protein induced by vita-min K absence or antagonist-II production is a strong predic-tive marker for extrahepatic metastases in early hepatocellularcarcinoma:A prospective evaluation[J]. BMC Cancer, 2011, 11:435.

[20] MIYAAKI H, NAKASHIMA O, KUROGI M, et al. Lens culinarisagglutinin-reactive alpha-fetoprotein and protein induced byvitamin K absence II are potential indicators of a poor progno-sis:A histopathological study of surgically resected hepatocel-lular carcinoma[J]. J Gastroenterol, 2007, 42 (12) :962-968.

[21] GAO FJ, CUI SX, CHEN MH, et al. Des-gamma-carboxyprothrombin increases the expression of angiogenic factors inhuman hepatocellular carcinoma cells[J]. Life Sci, 2008, 83 (23-24) :815-820.

[22] GOTOH M, NAKATANI T, MASUDA T, et al. Prediction of in-vasive activities in hepatocellular carcinomas with special refer-ence to alpha-fetoprotein and des-gamma-carboxypro-thrombin[J]. Jpn J Clin Oncol, 2003, 33 (10) :522-526.

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