异常凝血酶原对乙型肝炎病毒相关肝癌肝动脉化疗栓塞联合射频消融后复发的预测价值

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摘要目的分析异常凝血酶原（PIVKA-Ⅱ）对乙型肝炎病毒（乙肝）相关肝癌肝动脉化疗栓塞（TACE）联合射频消融（RFA）治疗后复发的预测价值。方法收集2014 年6 月至2019 年11 月深圳市第三人民医院收治的99 例乙型肝炎表面抗原（HBsAg）阳性的肝癌患者，所有患者接受TACE 联合RFA 治疗。至少随访2 年观察患者复发情况，依据ROC 曲线分析PIVKA-Ⅱ预测复发的最佳截断值，采用Kaplan-Meier 法绘制曲线图明确PIVKA-Ⅱ与肿瘤复发的关系，Cox 回归分析影响复发的独立危险因素。结果随访时间11～104.7 个月，中位随访时间为36.9个月。至随访结束，99 例患者中有72 例复发，复发率为72.7%。ROC 曲线分析确定PIVKA-Ⅱ预测复发的最佳截断值为43.6 mAu/ml，敏感度为68.1%，特异度为70.4%，约登指数0.385，ROC 曲线下面积0.66。以PIVKA-Ⅱ截断值43.6 mAu/ml 为界，≥43.6 mAu/ml 为高水平组，57 例；＜43.6 mAu/ml 为低水平组，42 例。高水平组和低水平组1、3、5 年肿瘤累积复发率分别为42%、81%、87%与35%、53%、80%，两组比较，差异有统计学意义（P＜0.05）。单因素分析显示，肿瘤数目、肿瘤最大径、临床分期、甲胎蛋白（AFP）、PIVKA-Ⅱ与肿瘤复发有关（P＜0.05）；Cox 回归分析显示，肿瘤数目、PIVKA-Ⅱ是乙肝相关肝癌治疗后复发的独立危险因素（P＜0.05）。结论 PIVKA-Ⅱ对乙肝相关肝癌治疗后复发有一定的预测价值。

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关键词 ：肝细胞癌, 肝动脉化疗栓塞, 射频消融, 异常凝血酶原, 复发

Abstract：Objective To analyze the predictive value of protein induced by vitamin K absence or antagonist Ⅱ(PIVKA-Ⅱ)in recurrence of hepatitis B related hepatocellular carcinoma after transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA).Methods From June 2014 to November 2019,99 patients with hepatitis B surface antigen (HBsAg)positive hepatocellular cancer in the Third People's Hospital of Shenzhen were collected,and all patients were treated with TACE combined with RFA.Patients should be followed up for at least 2 years to observe recurrence.The optimal cut-off value of PIVKA-Ⅱprediction of recurrence was analyzed according to ROC curve,and the Kaplan-Meier method was used to plot the relationship between PIVKA-Ⅱand tumor recurrence,and Cox regression was analyzed to affect the independent risk factors for recurrence.Results The follow-up time was 11-104.7 months,and the median follow-up time was 36.9 months.By the end of follow-up,72 of 99 patients had recurrence,with a recurrence rate of 72.7%.ROC curve analysis determined that the optimal cut-off value of PIVKA-Ⅱfor predicting recurrence was 43.6 mAu/ml,sensitivity was 68.1%,specificity was 70.4%,Youden index was 0.385,and area under ROC curve was 0.66.The cut-off value of PIVKA-Ⅱwas 43.6 mAu/ml,and the high level group (57 cases) was≥43.6 mAu/ml.The low level group (42 cases)was＜43.6 mAu/ml.The cumulative recurrence rates at 1,3 and 5 years were 42%,81%and 87%in the high level group and 35%,53%and 80%in the low level group,respectively,and the differences were statistically significant (P＜0.05).Univariate analysis showed that the number of tumors,maximum tumor diameter,clinical stage,alpha fetoprotein (AFP),PIVKA-Ⅱwere associated with tumor recurrence(P＜0.05).Cox regression analysis showed that the number of tumors and PIVKA-Ⅱwere independent risk factors for recurrence of hepatitis B related hepatocellular carcinoma after treatment (P＜0.05).Conclusion PIVKA-Ⅱhas a certain predictive value for the recurrence of hepatitis B related hepatocellular carcinoma after treatment.

Key words： Hepatocellular carcinoma Transcatheter arterial chemoembolization Radiofrequency ablation Protein induced by vitamin K absence or antagonist Ⅱ Recurrence

基金资助:广东省深圳市第三人民医院院内课题（G202 2112）。

引用本文:

刘洵祺1；才袁2；汪莹2；黄湘荣3▲. 异常凝血酶原对乙型肝炎病毒相关肝癌肝动脉化疗栓塞联合射频消融后复发的预测价值[J]. 中国当代医药, 2024, 31(15): 52-56.
LIU Xunqi1 CAI Yuan2 WANG Ying2 HUANG Xiangrong3▲. Predictive value of protein induced by vitamin K absence or antagonist Ⅱfor recurrence after transcatheter arterial chemoembolization combined with radiofrequency ablation for hepatitis B-related hepatocellular carcinoma. 中国当代医药, 2024, 31(15): 52-56.

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