MRI联合血清AFP-L3和VEGF水平预测TACE术治疗的原发性肝癌患者预后的价值*

doi:10.3969/j.issn.1672-5069.2023.04.026

摘要/Abstract

摘要： 目的探讨磁共振成像(MRI)联合血清甲胎蛋白异质体3(AFP-L3)和血管内皮细胞生长因子(VEGF)水平预测经导管肝动脉化疗栓塞术(TACE)治疗的原发性肝癌(PLC)患者预后的价值。方法 2019年1月～2020年6月我院收治的64例PLC患者,均接受TACE术治疗,随访至2022年6月。术前术后接受MRI检查,采用ELISA法检测血清AFP-L3和VEGF水平,常规检测血常规,计算中性粒细胞计数与淋巴细胞计数比值(NLR)和血小板与淋巴细胞比率(PLR)。应用单因素和多因素Logistic回归分析,应用受试者工作特征曲线(ROC)评估各指标判断TACE术后死亡的效能。结果在TACE术后3个月,经MRI检查,在64例PLC患者中,发现CR有28例(43.8%),PR有16例(25.0%),SD有12例(18.8%),PD有8例(12.5%)。疾病控制率(DCR)为87.5%;本组2年内死亡30例(46.9%);死亡与生存患者TACE术后近期肿瘤直径、瘤组织坏死、肿瘤边缘呈连续多结节、肿瘤包膜不完整、血清AFP-L3、VEGF、NLR、PLR和DCR方面,存在显著性差异(P＜0.05);经多因素Logistic回归分析发现,肿瘤边缘呈连续多结节、肿瘤包膜不完整、血清AFP-L3和VEGFL水平高、NLR和PLR高是TACE术后患者死亡的独立危险因素(P＜0.05);在TACE术后,血清AFP-L3水平大于80.9μg/mL、血清VEGF水平大于119.9μmol/L、NLR大于2.3或PLR大于13.9,提示患者预后不良,其灵敏度和特异度分别为69.1%和68.2%,88.2%和68.2%,73.5%和86.4%,和83.8%和77.3%。结论了解TACE术后影响PLC患者死亡的危险因素将有助于制定合理的治疗方案和补充治疗,提高生存率。

关键词: 原发性肝癌, 经导管肝动脉化疗栓塞术, 磁共振成像, 甲胎蛋白异质体3, 血管内皮细胞生长因子, 预后

Abstract: Objective The aim of this study was to explore the value of magnetic resonance imaging (MRI) as well as serum alpha fetal protein heteromorphism 3 (AFP-L3) and vascular endothelial growth factor (VEGF) levels as predictors of tumor response in patients with primary liver cancer (PLC) undergoing transcatheter hepatic artery chemoembolization (TACE). Methods 64 patients with PLC were encountered in our hospital between January 2019 and June 2020, and all patients underwent TACE and followed-up for two years. The patients were checked-up by MRI regularly after TACE, and serum AFP-L3 and VEGF levels were detected by ELISA. The routine blood examination was carried out, and the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were collected.The unconditional multivariate Logistic stepwise regression analysis was adopted, and the predictive value of serum AFP-L3, VEGF, and NLR and PLR for prognosis of patients with PLC after TACE was analyzed by receiver operating characteristic curve (ROC). Results Three months after TACE, the MRI scan showed complete remission in 28 cases(43.8%), partial remission in 16 cases (25.0%), stable disease in 12 cases (18.8%) and progressive disease in 8 cases (12.5%), with the disease control rate (DCR) of 87.5% in our series; at the end of two year follow-upperiod, 30 patients (46.9%) died; the tumor diameters, cancerous tissue necrosis, and the DCR were significantly different between deads and survivals (P＜0.05); the multivariate Logistic regression analysis showed that the continuous multi-nodular tumormargin, incomplete tumor envelope, high serum AFP-L3 and VEGF levels, and the increasedNLR and the PLR were the independent risk factors for poor prognosis in patients with PLC after TACE(P＜0.05); the sensitivities and the specificities were 69.1% and 68.2%, 88.2% and 68.2%, 73.5% and 86.4%, and 83.8%and 77.3% when serum AFP-L3 level greater than 80.9μg/mL, serum VEGF level greater than 119.9μmol/L, the NLR greater than 2.3 or the PLR greater than 13.9 were set as the cut-off-value in predicting poor prognosis in patients with PLC after TACE. Conclusion The clinicians should take risk factors for poor prognosis into considerationin in patients with PLC after TACE, and make therapy strategy carefully and appropriately, which might improve the prognosis.

Key words: Hepatoma, Transcatheter hepatic artery chemoembolization, Magnetic resonance imaging, Fetal protein heteromorphism 3, Vascular endothelial growth factor, Prognosis

陈钰, 陈斌斌, 赵静, 吴彬彬. MRI联合血清AFP-L3和VEGF水平预测TACE术治疗的原发性肝癌患者预后的价值^*[J]. 实用肝脏病杂志, 2023, 26(4): 556-559.

Chen Yu, Chen Binbin, Zhao Jing, et al. MRI as well as serum AFP-L3 and vascular endothelial growth factor levels as predictors of tumor response in patients with primary liver cancer undergoing TACE[J]. Journal of Practical Hepatology, 2023, 26(4): 556-559.

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MRI联合血清AFP-L3和VEGF水平预测TACE术治疗的原发性肝癌患者预后的价值^*

MRI as well as serum AFP-L3 and vascular endothelial growth factor levels as predictors of tumor response in patients with primary liver cancer undergoing TACE

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