肝细胞癌根治性切除术患者术前血清AFP、VEGF水平及肿瘤组织Ki-67表达水平与早期复发的关系  

Correlations between preoperative serum AFP,VEGF concentrations,and expression level of Ki-67 in tumour tissues and early recurrence after radical resection in patients with hepatocellular carcinoma

作　　者：龚培贤 孙涛[1] 刘金玮 范正军[1] GONG Peixian;SUN Tao;LIU Jinwei;FAN Zhengjun(Department of Hepatopancreatobiliary Surgery,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院肝胆胰外科,郑州450052

出　　处：《山东医药》2022年第15期28-32,共5页Shandong Medical Journal

基　　金：河南省科技攻关项目(182102310143)。

摘　　要：目的探讨肝细胞癌(HCC)患者根治性切除术前血清AFP、VEGF浓度及肿瘤组织中Ki-67表达水平与术后早期(术后2年内)复发的关系。方法肝癌根治性切除术患者145例,早期复发63例(复发组),早期未复发82例(未复发组)。采用ELISA法检测两组术前血清AFP、VEGF,采用免疫组织化学法检测两组术中所取肿瘤组织中Ki67。比较两组术前血清AFP、VEGF浓度,术后肿瘤组织Ki-67表达水平及其他可能影响术后早期复发的指标。采用COX比例风险回归分析HCC患者根治性切除术后早期复发的独立影响因素。采用受试者特征曲线(ROC)评估术前血清AFP、VEGF浓度及术后肿瘤组织中Ki-67表达水平对HCC患者根治性切除术后早期复发的预测效能。采用Kaplan-Meier法比较不同血清AFP、VEGF浓度、不同肿瘤组织Ki-67表达水平的HCC患者根治性切除术后早期中位无复发生存时间(RFS)。结果两组肿瘤最大直径、术前AFP、术前VEGF、肿瘤微血管侵犯、脉管癌栓、肿瘤组织中Ki-67比较,P均<0.05。术前AFP>200 ng/mL(HR=1.880,95%CI=1.063~3.324,P=0.030)、VEGF>160 pg/mL(HR=1.899,95%CI=1.084~3.329,P=0.025)、肿瘤组织Ki-67高表达(HR=1.885,95%CI=1.038~3.424,P=0.037)是HCC患者根治性切除术后早期复发的独立危险因素。血清AFP、VEGF,组织Ki-67预测HCC患者根治性切除术后早期复发的曲线下面积分别为0.742、0.677、0.664,敏感度分别为81.0%、42.9%、73.0%,特异度分别为59.8%、95.1%、56.1%;三者共同检测时,曲线下面积为0.762,敏感度为58.7%,特异度为89.0%。根治性切除术前血清AFP≤200 ng/mL与AFP>200 ng/mL的HCC患者RFS分别为39.33、25.19个月;血清VEGF≤160 pg/mL与>160 pg/mL者RFS分别为38.34、29.28个月;组织Ki-67高表达与低表达的HCC患者RFS分别为28.72、37.53个月,不同血清AFP、VEGF浓度,不同肿瘤组织Ki-67表达水平之间比较,P均<0.05。结论术前血清AFP>200 ng/mL、VEGF>160 pg/mL以及术后肿瘤组织中Ki-67高表达Objective To investigate the correlations between preoperative serum AFP,VEGF concentrations,the expression level of Ki-67 in the tumour tissues and early recurrence(within 2 years after surgery)after radical resection in patients with hepatocellular carcinoma(HCC).Methods Totally 145 patients underwent radical resection of hepatocel⁃lular carcinoma,including 63 cases of early recurrence patients(recurrence group)and 82 cases of non-early recurrence patients(non-recurrence group).ELISA was used to detect preoperative serum AFP and VEGF concentrations,and immu⁃nohistochemistry was used to detect the expression level of Ki-67 in the tumour tissues taken intraoperatively.We com⁃pared the preoperative serum AFP and VEGF concentrations,postoperative expression levels of Ki-67 in tumour tissues and other indicators that might affect early postoperative recurrence between the two groups.Cox proportional hazards re⁃gression was used to analyze the independent influencing factors for early recurrence after radical resection in HCC pa⁃tients.Receiver operating characteristic(ROC)curve was used to analyze the predictive efficacy of preoperative serum AFP,VEGF concentrations and the expression of Ki-67 in postoperative tumour tissues on early postoperative recurrence after radical resection of hepatocellular carcinoma.Kaplan-Meier method was used to compare the early median recurrencefree survival time(RFS)after radical resection in HCC patients with different serum AFP,VEGF concentrations and differ⁃ent expression levels of Ki-67 in tumour tissues.Results Significant differences were found in the maximum tumour di⁃ameter,preoperative AFP,preoperative VEGF,tumour microvascular invasion,vascular cancer thrombus and Ki-67 ex⁃pression levels in the tumour tissues between two groups(all P<0.05);preoperative AFP>200 ng/mL(HR=1.880,95%CI=1.063-3.324,P=0.030),preoperative VEGF>160 pg/mL(HR=1.899,95%CI=1.084-3.329,P=0.025)and high expression of Ki-67(HR=1.885,95%CI=1.038-3.424,0.037)were independent risk factors for

关 键 词：甲胎蛋白 血管内皮生长因子 KI-67抗原 肿瘤复发 肝细胞癌 

分 类 号：R735.7[医药卫生—肿瘤]