术前血清糖类抗原19-9水平对肝细胞癌患者肝切除术后预后的影响  

Impact of preoperative serum carbohydrate antigen 19-9 levels on prognosis of hepatocellular carcinoma patients after partial hepatectomy

作　　者：赵婧菲 张杰[1] 向邦德[1] Zhao Jingfei;Zhang Jie;Xiang Bangde(Department of Hepatobiliary Surgery,Guangxi Medical University Affiliated Tumor Hospital,Nanning 530021,China)

机构地区：[1]广西医科大学附属肿瘤医院肝胆外科,南宁530021

出　　处：《中华肝胆外科杂志》2021年第5期326-330,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金(81960450);国家科技重大专项(2017ZX10203207);广西重点研发计划(桂科AA18221001)。

摘　　要：目的探讨肝细胞癌患者术前血清糖类抗原19-9(CA19-9)水平与肝切除术预后的关系。方法回顾分析2012年1月至2017年12月在广西医科大学附属肿瘤医院行肝切除术的1102例肝细胞癌患者临床资料,其中男性960例,女性142例,平均年龄51岁。随访复发和生存情况。应用X-tile软件确定55 U/ml作为CA19-9预测预后的最佳界值,并据此将入组患者分为低水平组(CA19-9≤55 U/ml,n=956)和高水平组(CA19-9>55 U/ml,n=146)。采用Kaplan-Meier法进行生存分析,log-rank检验比较生存率,Cox回归分析肝细胞癌患者预后的危险因素。结果低水平组术后1、3、5年累积生存率分别为85.0%、68.2%、60.9%,高于高水平组80.1%、58.2%、47.0%,差异有统计学意义(P<0.05)。低水平组术后1、3、5年累积无复发生存率分别为60.5%、44.6%、37.9%,高于高水平组53.4%、33.3%、25.1%,差异有统计学意义(P<0.05)。Cox回归多因素分析,CA19-9>55 U/ml(HR=1.323,95%CI:1.070~1.636,P=0.010)的肝细胞癌患者肝切除术后复发风险高,CA19-9>55 U/ml(HR=1.511,95%CI:1.163~1.964,P=0.002)的肝细胞癌患者肝切除术后生存预后差。结论术前血清CA19-9>55U/ml是肝细胞癌患者肝切除术后生存和复发的独立危险因素,CA19-9对肝细胞癌患者的预后具有一定的预测价值。Objective To study the relationship between preoperative serum carbohydrate antigen 19-9(CA19-9)levels and long-term prognosis after partial hepatectomy in patients with hepatocellular carcinoma(HCC).Methods The clinical data of 1102 patients with HCC who underwent partial hepatectomy at the Affiliated Tumor Hospital of Guangxi Medical University from January 2012 to December 2017 were retrospectively analyzed.There were 960 males and 142 females,with an average age of 51 years.The X-tile software determined the best cut-off value of CA19-9 to be 55U/ml.The enrolled patients were then divided into the low-level(CA19-9≤55 U/ml,n=956)and high-level(CA19-9>55 U/ml,n=146)groups.The Kaplan-Meier method was used to analyze survival,and the log-rank test was performed to evaluate survival rates.The prognostic risk factors of HCC were calculated by the Cox proportional hazards model.Results The 1,3,and 5-year survival rates for the low-level group were 85.0%,68.2%,and 60.9%,respectively,which were significantly higher than those of the high-level group of 80.1%,58.2%,and 47.0%,respectively(P<0.05).The 1,3,and 5-year recurrence-free survival rates of the low level group were 60.5%,44.6%,and 37.9%respectively,which were significantly higher than those in the high-level group of 53.4%,33.3%,and 25.1%,respectively(P<0.05).Cox regression analysis showed that patients with CA19-9>55 U/ml(HR=1.323,95%CI:1.070-1.636,P=0.010)had a higher risk of recurrence after hepatectomy,while patients with CA19-9>55 U/ml(HR=1.511,95%CI:1.163-1.964,P=0.002)had a poor prognosis after hepatectomy.Conclusions Preoperative serum level of CA19-9>55 U/ml was an independent risk factor for survival and recurrence of HCC patients after partial hepatectomy.CA19-9 had a significant predictive value for prognosis of HCC patients who underwent partial hepatectomy.

关 键 词：癌 肝细胞 肝切除术 糖类抗原19-9 预后 

分 类 号：R735.7[医药卫生—肿瘤]