晚期糖基化终末产物受体对原发性肝癌患者根治术后复发转移及死亡的预测价值  

Value of receptor for advanced glycation end product to the prediction of recurrence/ metastasis and death after radical resection of primary hepatocellular carcinoma

作　　者：买尔旦·赛力木[1] 阿里旦·艾尔肯[2] 柯于必 金钟[1] Maierdan SAILIMU;Alidan AIERKEN;KE Yu-bi;JIN Zhong(Department of Comprehensive Surgery-,the First A ffiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang Uygur Autonomous Region 830054,China;Department of General Medicine,the First Affiliated Hospital of Xinjiang Medical University^Ururnqi,Xinjiang Uygur Autonomous Region 830054,China)

机构地区：[1]新疆医科大学第一附属医院综合外科,新疆维吾尔自治区乌鲁木齐830054 [2]新疆医科大学第一附属医院全科医学科,新疆维吾尔自治区乌鲁木齐830054

出　　处：《中华实用诊断与治疗杂志》2022年第1期22-26,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：新疆维吾尔自治区自然科学基金(2017D01C331)。

摘　　要：目的观察原发性肝癌患者癌组织晚期糖基化终末产物受体(receptor for advanced glycation end product, RAGE)表达变化,探讨其预测原发性肝癌患者根治术后复发转移及死亡的价值。方法 134例原发性肝癌患者,均行肝癌根治术,术后给予辅助性肝动脉化疗栓塞治疗、分子靶向治疗或免疫治疗等。取手术切除癌组织及癌旁组织,采用免疫组织化学法检测RAGE阳性表达率,比较不同临床病理特征肝癌患者RAGE阳性表达率。对134例患者随访5年,记录术后复发转移及死亡情况,比较RAGE阳性表达与阴性表达者术后5年无病生存期、复发转移率及病死率。以术后5年复发转移及死亡者为预后不良组,其余为预后良好组,比较预后不良组与预后良好组一般临床资料和RAGE阳性表达率;多因素Cox回归分析原发性肝癌患者根治术后复发转移及死亡的影响因素。结果肝癌组织RAGE阳性表达率(64.9%)高于癌旁组织(15.7%)(χ^(2)=5.678,P=0.021)。134例患者中RAGE阳性表达87例,肿瘤直径≥5 cm(79.7%)、病理分级低分化(84.6%)、有微血管侵犯(80.3%)及血清甲胎蛋白(alpha fetoprotein, AFP)≥400μg/L(72.8%)者RAGE阳性表达率分别高于肿瘤直径<5 cm、病理分级中高分化、无微血管侵犯及血清AFP<400μg/L者(46.7%、52.4%、47.6%、47.6%)(P<0.05)。134例患者中术后5年复发转移77例,其中69例死亡。RAGE阳性表达者术后5年中位无病生存期(17个月)短于RAGE阴性表达者(28个月)(P<0.05),术后5年复发转移率(66.7%)及病死率(58.6%)高于RAGE阴性表达者(40.4%、38.3%)(P<0.05)。预后不良组肿瘤直径≥5 cm(67.5%)、病理分级低分化(51.9%)、有微血管侵犯(71.4%)比率、血清AFP水平[(423.4±61.4)μg/L]、RAGE阳性表达率(75.3%)均高于预后良好组[38.6%、21.1%、28.1%、(216.7±32.5)μg/L、50.9%](P<0.05)。RAGE阳性表达(HR=1.823,95%CI:1.542~2.136,P=0.035)、有微血管侵犯(HR=2.367,95%CI:2.113~2.569,P<0.001)是原发性肝癌患Objective To observe the expression of receptor for advanced glycation end product(RAGE) in patients with primary hepatocellular carcinoma(HCC), and to explore its value to the prediction of recurrence/metastasis and death after radical resection of HCC. Methods Totally 134 patients with primary HCC underwent radical resection, followed with adjuvant hepatic artery chemoembolization, molecular targeted therapy or immunotherapy. The positive rate of RAGE was detected by immunohistochemical method in the resected cancer tissues and paracancerous tissues. and was compared in patients with primary HCC in different clinicopathological features. All 134 patients were followed up for 5 years. The postoperative recurrence/metastasis and death were recorded. The postoperative 5-year disease-free survival, the rate of recurrence/metastasis, and the fatality were compared between patients with positive and negative RAGE. The patients with recurrence/metastasis or death in 5 years after operation were regarded as poor prognosis group, and the other patients were regarded as good prognosis group. The general clinical data and the positive rate of RAGE were compared between poor prognosis group and good prognosis group. Multivariate Cox regression analysis was done to assess the influencing factors of reccurrence/metastasis and death in HCC patients. Results The positive rate of RAGE was higher in cancer tissues(64.9%)than that in paracancerous tissues(15.7%)(χ^(2)=5.678,P=0.021).Among these 134 patients,RAGE was positive in 87 patients.The positive rates were higher in patients with tumor diameter≥5 cm,low pathologic grade,microvascular invasion and serum alpha fetoprotein(AFP)≥400μg/L(79.7%,84.6%,80.3%,72.8%)than those in patients with tumor diameter <5 cm,medium and high pathological grade,no microvascular invasion and serum AFP<400μg/mL(46.6%,52.4%,47.6%,47.6%)(P<0.05).Among these 134 patients,77 developed recurrence/metastasis and 69 died in 5 years after operation.The postoperative median 5-year disease-free survi

关 键 词：原发性肝癌 晚期糖基化终末产物受体 复发转移 死亡 

分 类 号：R735.7[医药卫生—肿瘤]