超声造影联合血清PIVKA-Ⅱ水平评估TACE治疗的老年肝细胞癌患者完全缓解价值分析*

doi:10.3969/j.issn.1672-5069.2025.02.028

实用肝脏病杂志 ›› 2025, Vol. 28 ›› Issue (2): 270-273.doi: 10.3969/j.issn.1672-5069.2025.02.028

超声造影联合血清PIVKA-Ⅱ水平评估TACE治疗的老年肝细胞癌患者完全缓解价值分析^*

周敏, 李涛, 王波玲

710032 西安市空军军医大学第一附属医院消化内科超声诊疗中心(周敏,李涛);消化内科(王波玲)

收稿日期:2023-10-31 出版日期:2025-03-10 发布日期:2025-03-11
通讯作者: 王波玲,E-mail:461358290@qq.com
作者简介:周敏,女,41岁,大学本科,副主任医师。研究方向:腹部超声诊断、超声造影和介入超声治疗研究。E-mail:zm18092925530@163.com
基金资助:
^*陕西省科技厅重点研发计划项目(编号:2022ZDLSF04-04)

Prediction of complete remission by contrast-enhanced ultrasonography and serum PIVKA-II levels in elderly patients with hepatocellular carcinoma after TACE therapy

Zhou Min, Li Tao, Wang Boling

Ultrasonic Diagnosis and Treatment Center, Department of Gastroenterology, First Affiliated Hospital, Air Force Medical University, Xi'an 710032, Shaanxi Province, China

Received:2023-10-31 Online:2025-03-10 Published:2025-03-11

摘要/Abstract

摘要： 目的探讨超声造影(CEUS)联合血清异常凝血酶原(PIVKA-Ⅱ)水平预测经动脉化疗栓塞(TACE)治疗老年肝细胞癌(HCC)患者完全缓解(CR)的效能。方法 2020年3月～2023年3月空军军医大学第一附属医院收治的87例老年HCC患者,均接受CEUS检查,检测增强造影造影剂上升时间(RT)、达峰时间(TTP)和峰值强度 (IMAX)。使用全自动免疫分析仪检测血清PIVKA-II水平。然后,所有患者均接受TACE治疗。应用受试者工作特征曲线(ROC)分析指标联合预测TACE术后获得CR的效能。结果在87例老年HCC患者中,在TACE治疗后,获得CR者27例(31.0%),部分缓解(PR)19例,疾病稳定(SD)28例,疾病进展(PD)13例,即未获得完全缓解率为69.0%;CR组术前CEUS检测的TTP为(35.3±3.2)s,显著长于未获得CR组【(18.3±3.5)s,P＜0.05】,血清PIVKA-Ⅱ水平为(1253.7±307.4)mAU/mL,显著低于未获得CR组【(2784.1±221.7)mAU/mL,P＜0.05】;经ROC分析显示,应用CEUS检测的TTP联合血清PIVKA-II水平预测TACE术后疗效的灵敏度为96.3%,特异度为88.3%,其效能显著优于两指标单独预测(P<0.05)。结论术前应用CEUS检查和血清PIVKA-Ⅱ水平可帮助预测TACE术治疗老年HCC患者的疗效,值得进一步研究验证。

关键词: 肝细胞癌, 肝动脉化疗栓塞术, 超声造影, 达峰时间, 异常凝血酶原Ⅱ, 完全缓解

Abstract: Objective The aim of this study was to investigate the prediction of complete remission (CR) by contrast-enhanced ultrasonography (CEUS) and serum prothrombin induced by vitamin K absence-II (PIVKA-II) levels in elderly patients with hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) therapy. Method 87 elderly patients with HCC were encountered in the First Affiliated Hospital, Air Force Medical University between March 2020 and March 2023, and all underwent CEUS to detect the rise time (RT), time to peak (TTP) and maximum of intensity (IMAX). Serum PIVKA-II levels were routinely assayed. Based on appropriate preparing, the TACE was conducted for every patient. The receiver operating characteristic (ROC) curve was applied to predict the efficacy of TACE. Result Out of the 87 patients with HCC, the CR was obtained in 27 cases(31.0%), and the partial remission, stable disease and progression disease were found in 19 cases, 28 cases and 13 cases, e.g., the non-CR rate was 69.0%; before TACE, the TTP by CEUS in patients with CR was (35.3±3.2)s, significantly longer than [(18.3±3.5)s, P＜0.05], while serum PIVKA-Ⅱ level was (1253.7±307.4)mAU/mL, much lower than [(2784.1±221.7)mAU/mL, P＜0.05] in patients with non-CR; the ROC analysis showed that the predicting performance of the combination of TTP and serum PIVKA-II level for CR after TACE was promising, with the sensitivity of 96.3% and the specificity of 88.3%, much superior to any parameters of the two alone (P<0.05). Conclusion Both the CEUS and serum PIVKA-II level could be used to predict CR in elderly patients with HCC after TACE, which needs further multi-center clinical study for verification.

Key words: Hepatoma, Transcatheter arterial chemoembolization, Contrast-enhanced ultrasonography, Time to peak, Prothrombin induced by vitamin K absence-II, Complete Remission

周敏, 李涛, 王波玲. 超声造影联合血清PIVKA-Ⅱ水平评估TACE治疗的老年肝细胞癌患者完全缓解价值分析^*[J]. 实用肝脏病杂志, 2025, 28(2): 270-273.

Zhou Min, Li Tao, Wang Boling. Prediction of complete remission by contrast-enhanced ultrasonography and serum PIVKA-II levels in elderly patients with hepatocellular carcinoma after TACE therapy[J]. Journal of Practical Hepatology, 2025, 28(2): 270-273.

参考文献

[1] Ghanaati H, Mohammadifard M, Mohammadifard M. A review of applying transarterial chemoembolization (TACE) method for management of hepatocellular carcinoma. J Family Med Prim Care, 2021, 10(10):3553-3560.
[2] 邢红宇,黄淑玲,卓书伟,等. 血清载脂蛋白A1及B对老年HCC患者术后生存率的预测价值. 中国老年学杂志,2020,40(20):4297-4300.
[3] 梅丽丽,聂磊. 超声时间-强度曲线定量评估对老年HCCRFA术后复发的预测价值. 中国老年学杂志,2021,41(23):5204-5207.
[4] Chang Y, Jeong SW, Young JJ, et al. Recent updates of transarterial chemoembolilzation in hepatocellular carcinoma. Int J Mol Sci, 2020, 21(21):8165.
[5] Wessner CE, Shaw CM, Stanczak M, et al. Contrast-enhanced ultrasound identifies patent feeding vessels in transarterial chemoembolization patients with residual tumor vascularity. Ultrasound Q, 2020, 36(3):218-223.
[6] Wang SY, Su TH, Chen BB, et al. Prothrombin induced by vitamin K absence or antagonist-II (PIVKA-II) predicts complete responses of transarterial chemoembolization for hepatocellular carcinoma. J Formos Med Assoc, 2022, 121(8):1579-1587.
[7] 中华人民共和国卫生和计划生育委员会医政医管局. 原发性肝癌诊疗规范(2017年版) . 中华消化外科杂志, 2017, 16(7) :635-647.
[8] 安天志,高高,靳勇,等.中国HCC经动脉化疗栓塞治疗(TACE)临床实践指南.中华医学杂志,2018,98:3811-3819.
[9] Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline(version 1.1). Eur J Cancer, 2009, 45(2) 228-247.
[10] Wilson SR, Lyshchik A, Piscaglia F, et al. CEUS LI-RADS : algorithm, implementation, and key differences from CT/MRI. AbdomRadiol(NY), 2018, 43( 1) :127-142.
[11] Chang Y, Jeong SW, Young JJ, et al. Recent updates of transarterial chemoembolilzation in hepatocellular carcinoma. Int J Mol Sci, 2020, 31;21(21):8165.
[12] Russo G, Mischi M, Scheepens W, et al. Angiogenesis in prostate cancer: onset, progression and imaging. BJU Int, 2012, 110(11 Pt C): E794-E808.
[13] Wiesinger I,Wigcermann P,Zausig N,et al.Percutaneous treatment of malignant liver lesions: evaluationof success using contrast-enhanced ultrasound (CEUS) andperfusion software. Ultrasehall Med, 2018, 39(4): 440447.
[14] Zhang O,Wu LL, Yang DH, et al. Clinical application of dynamic contrast enhanced ultrasound in monitoring thetreatment response of chemoradiotherapy of pancreatic ductaladenocarcinoma. Clin Hemorheol Microcirc, 2020, 75(3):325-334.
[15] Youk JH, Lee JM, Kim CS. Therapeutic response evaluation of malignant hepatic masses treated by interventional procedureswith contrast-enhanced agent detection imaging. Ultrasound Med,2003,22(9):911-920.
[16] Zhan Y, Zhou F, Yu X, et al. Quantitative dynamic contrast-enhanced ultrasound may help predict the outcome of hepatocellular carcinoma after microwave ablation. Int J Hyperthermia, 2019, 35(1):105-111.
[17] 黄仪妮,周建华. 超声造影定量分析在肿瘤诊疗中的应用. 肿瘤影像学,2022,31(1):6-10.
[18] Liebman HA, Furie BC, Tong MJ, et al. Desgamma-carboxy (abnormal) prothrombin as a serum marker of primary hepatocellular carcinoma. N Engl J Med, 1984:310(22):1427-1431.
[19] Feng H, Li B, Li Z, et al. PIVKA-II serves as a potential biomarker that complements AFP for the diagnosis of hepatocellular carcinoma. BMC Cancer, 2021, 21(1):401.
[20] Ma XL, Zhu J, Wu J, et al. Significance of PIVKA-II levels for predicting microvascular invasion and tumor cell proliferation in Chinese patients with hepatitis B virus-associated hepatocellular carcinoma. Oncol Lett, 2018, 15(6):8396-8404.
[21] 宣之东,张雷,李秀娟,等. 超声造影定量分析与血管内皮生长因子对甲胎蛋白阴性复发性肝癌患者肝动脉化疗栓塞术后疗效的预测分析. 中国医学前沿杂志(电子版),2021,13(6):43-47.

超声造影联合血清PIVKA-Ⅱ水平评估TACE治疗的老年肝细胞癌患者完全缓解价值分析^*

Prediction of complete remission by contrast-enhanced ultrasonography and serum PIVKA-II levels in elderly patients with hepatocellular carcinoma after TACE therapy

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	李全维, 高明慧, 寇卜心, 柴梦音, 霍云飞, 豆双双, 庞丽君, 石英, 刘晓霓. p65通过调控脂代谢影响HepG2细胞增殖研究^*[J]. 实用肝脏病杂志, 2025, 28(2): 173-177.
[2]	何培, 冯磊, 曹向红, 王佳, 彭传梅, 孔凡斌, 陶春晖, 张振华. RNA m6A甲基化与肝细胞癌的相关性及对肝癌患者预后作用的Meta分析^*[J]. 实用肝脏病杂志, 2025, 28(2): 254-257.
[3]	严隽瑶, 尹国文, 徐清宇, 尤然, 秦锦霞. 阿替利珠单抗联合射频消融术治疗不可切除的肝细胞癌患者临床疗效和安全性研究^*[J]. 实用肝脏病杂志, 2025, 28(2): 262-265.
[4]	李晶晶, 范智慧, 梅冬雪, 张丽, 郝玉静, 张冬艳. 肝脏实性占位性病变超声造影声像学特征及其诊断价值分析^*[J]. 实用肝脏病杂志, 2025, 28(2): 274-277.
[5]	江爱芳, 陈华芳, 张聪. 肝血管瘤超声造影表现分析^*[J]. 实用肝脏病杂志, 2025, 28(2): 282-285.
[6]	郭江红, 杨晶, 王欢. 多模态超声造影诊断肝移植术后动脉并发症应用价值分析^*[J]. 实用肝脏病杂志, 2025, 28(2): 294-297.
[7]	牛日雨, 王益杰, 王欣, 李成忠. 基于癌症基因组图谱数据库双硫死亡相关LncRNA构建肝细胞癌预后模型及其效能分析[J]. 实用肝脏病杂志, 2025, 28(1): 128-131.
[8]	伏林, 张龄尹, 魏倩. MRI在脂肪肝背景下对局灶性结节性病变定性诊断价值分析^*[J]. 实用肝脏病杂志, 2025, 28(1): 140-143.
[9]	张少博, 张树庚, 刘连新. 免疫治疗肝细胞癌肝移植患者现状和前景展望^*[J]. 实用肝脏病杂志, 2024, 27(6): 801-803.
[10]	郑浩, 张树庚, 王嘉倍, 郭亚飞. 肝移植术治疗肝细胞癌患者肿瘤复发再治疗策略^*[J]. 实用肝脏病杂志, 2024, 27(6): 804-807.
[11]	朱泽斌, 张树庚, 刘连新. 靶向和免疫治疗原发性肝癌:肝移植术前降期治疗应用进展^*[J]. 实用肝脏病杂志, 2024, 27(6): 808-811.
[12]	曾旺, 蔡晓曼, 葛尚. 肝内胆管细胞癌与肝细胞癌病灶MRI增强扫描表现差异分析^*[J]. 实用肝脏病杂志, 2024, 27(6): 907-910.
[13]	丹巴玉珍, 程盼. 增强MRI检查诊断HCC价值研究^*[J]. 实用肝脏病杂志, 2024, 27(6): 911-914.
[14]	杨佳欣, 杨紫郡, 陈卫. 双源CT双能量TNC技术图像质量与诊断肝细胞癌效能分析^*[J]. 实用肝脏病杂志, 2024, 27(6): 915-918.
[15]	王玲玲, 姚敏, 姚登福. 肝细胞癌进展过程中KLFs异常表达及其检测的临床价值研究进展^*[J]. 实用肝脏病杂志, 2024, 27(6): 953-956.