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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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

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