术前PIVKA-II水平对肝细胞癌患者行根治性切除术后生存和复发的预测价值  

Preoperative PIVKA-Ⅱlevels for predicting the survival and recurrence for patients undergoing curative resection of hepatocellular carcinoma

作　　者：尹东旭 刁永康 王明达 李超 姚岚清 顾丽慧 徐家豪 徐新飞 沈锋 杨田 YIN Dongxu;DIAO Yongkang;WANG Mingda;LI Chao;YAO Lanqing;GU Lihui;XU Jiahao;XU Xinfei;SHEN Feng;YANG Tian(School of Public Health,Hangzhou Medical College,Hangzhou,Zhejiang 310013,China;Department of Hepatobiliary Surgery,the Third Affiliated Hospital of Naval Medical University(Eastern Hepatobiliary Surgery Hospital),Shanghai 200438,China)

机构地区：[1]杭州医学院公共卫生学院,浙江杭州310013 [2]海军军医大学第三附属医院(东方肝胆外科医院)肝胆外科,上海200438

出　　处：《肝胆胰外科杂志》2024年第12期709-715,共7页Journal of Hepatopancreatobiliary Surgery

基　　金：国家自然科学基金项目(82273074)。

摘　　要：目的探讨维生素K缺乏或拮抗剂诱导的蛋白质Ⅱ(PIVKA-Ⅱ)在肝细胞癌(HCC)患者根治性切除术后长期预后中的预测价值。方法回顾性分析2018年1月至2022年12月在东方肝胆外科医院行根治性肝癌切除的792例患者临床资料。根据术前2周内PIVKA-Ⅱ水平,将患者分为PIVKA-Ⅱ正常组(<40 mAU/mL,n=179)、高PIVKA-Ⅱ组(40~399 mAU/mL,n=245)及极高PIVKA-Ⅱ组(>399 mAU/mL,n=368)。比较三组间临床特征和术后结局,采用Kaplan-Meier法分析总生存时间(OS)和复发时间(TTR),采用Cox回归分析影响HCC患者术后预后的危险因素。结果高PIVKA-Ⅱ组和极高PIVKA-Ⅱ组患者的OS和TTR明显低于PIVKA-Ⅱ正常组(P<0.001)。多因素Cox回归分析显示,高PIVKA-Ⅱ水平(HR 1.602,95%CI 1.807-2.362,P<0.001)和极高PIVKA-Ⅱ水平(HR 2.457,95%CI 1.675-3.603,P<0.001)是较差OS的独立危险因素;极高PIVKA-Ⅱ水平是较短TTR(HR 1.790,95%CI 1.350-2.304,P<0.001)的独立危险因素。结论术前PIVKA-Ⅱ水平可作为HCC根治术后生存和复发的独立预测指标,对PIVKA-Ⅱ水平进行分级评估,有助于判断预后风险,指导术后个体化随访和辅助治疗。Objective To investigate the prognostic value of protein induced by vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ)for long-term outcome in patients with hepatocellular carcinoma(HCC)after curative resection.Methods The clinical data of 792 patients who underwent curative hepatectomy for HCC at Eastern Hepatobiliary Surgery Hospital between Jan.2018 and Dec.2022 were retrospectively analyzed.Based on preoperative PIVKA-Ⅱlevels within 2 weeks before surgery,patients were stratified into normal PIVKA-Ⅱgroup(<40 mAU/mL,n=179),high PIVKA-Ⅱgroup(40-399 mAU/mL,n=245),and extremely high PIVKA-Ⅱgroup(>399 mAU/mL,n=368).Clinical characteristics and postoperative outcomes were compared among the three groups.Overall survival(OS)and time to recurrence(TTR)were analyzed by using Kaplan-Meier method.Risk factors affecting postoperative prognosis were assessed by using Cox regression analysis.Results Compared with the normal PIVKA-Ⅱgroup,both high and extremely high PIVKA-Ⅱgroups demonstrated significantly worse OS and TTR(P<0.001).Multivariate Cox regression analysis identified high PIVKA-Ⅱlevel(HR 1.602,95%CI 1.807-2.362,P<0.001)and extremely high PIVKA-Ⅱlevel(HR 2.457,95%CI 1.675-3.603,P<0.001)as independent risk factors for poorer OS.Extremely high PIVKA-Ⅱlevel was also an independent risk factor for shorter TTR(HR 1.790,95%CI 1.350-2.304,P<0.001).Conclusion Preoperative PIVKA-Ⅱlevels can serve as an independent prognostic indicator for survival and recurrence of HCC after curative resection.Stratified assessment of PIVKA-Ⅱlevels aids in determining prognosis risk and guiding postoperative personalized followup and adjuvant therapy.

关 键 词：维生素K缺乏或拮抗剂诱导的蛋白质Ⅱ 肝细胞癌 生存 复发 肝切除术 

分 类 号：R735.7[医药卫生—肿瘤]