术前CA19-9预测HBV相关性肝细胞癌R0切除术后复发的价值

doi:10.3877/cma.j.issn.2095-3232.2016.05.011

目的

探讨术前血清CA19-9预测HBV相关性肝细胞癌（肝癌）R0切除术后复发的价值。

方法

回顾性分析2002年1月至2012年12月在青岛大学医学院附属医院实施R0切除术的554例HBV相关性肝癌患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男470例，女84例；年龄17～82岁，中位年龄55岁。根据随访结果，绘制术前血清CA19-9预测肝癌术后复发的受试者工作特征（ROC）曲线，确定CA19-9界值。根据CA19-9界值将患者分为CA19-9升高组和CA19-9正常组。两组生存率比较采用Z检验。

结果

CA19-9预测肝癌术后复发界值22.2 kU/L，CA19-9升高组258例，正常组296例。CA19-9升高组和正常组中位无病生存时间分别为30.0、49.5个月，1、2、3、4、5、10年无病生存率分别为78.1%、57.0%、46.8%、44.6%、33.2%、16.9%和74.7%、61.1%、55.3%、54.4%、46.8%、38.7%，两组4、5、10年无病生存率比较差异有统计学意义（Z=5.315，7.107，11.444；P<0.05）。

结论

术前血清CA19-9是预测HBV相关性肝癌R0切除术后远期复发的指标。

关键词: 癌，肝细胞, 糖链抗原19-9, 肝炎，乙型, 肿瘤复发，局部, 无病生存

Objective

To investigate the value of preoperative serum carbohydrate antigen (CA)19-9 in predicting the recurrence of hepatitis B virus (HBV) related hepatocellular carcinoma (HCC) after R0 resection.

Methods

Clinical data of 544 patients with HBV related HCC undergoing R0 resection in the Affiliated Hospital of Qingdao University Medical College from January 2002 to December 2012 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. There were 470 males and 84 females, aged from 17 to 82 years old with a median age of 55 years old. According to the follow-up results, the receiver operating characteristic (ROC) curve of preoperative serum CA19-9 predicting the postoperative recurrence of HCC was drawn and the cut-off point of CA19-9 was determined. The patients were divided into the CA19-9 increasing group and CA19-9 normal group according to the cut-off point of CA19-9. The survival rates of two groups were compared by Z test.

Results

The cut-off point of CA19-9 predicting the postoperative recurrence of HCC was 22.2 kU/L, by which 258 cases were assigned in the CA19-9 increasing group and 296 cases in the CA19-9 normal group. The median disease free survival (DFS) time in the CA19-9 increasing group and CA19-9 normal group was respectively 30.0 and 49.5 months, and the 1-, 2-, 3-, 4-, 5-, and 10-year DFS rates were respectively 78.1%, 57.0%, 46.8%, 44.6%, 33.2%, 16.9% and 74.7%, 61.1%, 55.3%, 54.4%, 46.8%, 38.7% , and significant differences were observed between two groups in the 4-, 5- and 10-year DFS rates(Z=5.315, 7.107, 11.444; P<0.05).

Conclusion

Preoperative serum CA19-9 is an index for predicting the long-term recurrence of HBV related HCC after R0 resection.

Key words: Carcinoma, hepatocellular, Carbohydrate antigen 19-9, Hepatitis B virus, Neoplasm recurrence, local, Disease-free survival

图1 术前血清CA19-9预测肝癌术后复发的ROC曲线

表1 CA19-9升高组和正常组HBV相关性肝癌患者无病生存率比较（%）

组别	例数	1年	2年	3年	4年	5年	10年
CA19-9升高组	258	78.1	57.0	46.8	44.6	33.2	16.9
CA19-9正常组	296	74.7	61.1	55.3	54.4	46.8	38.7
Z值	?	1.285	0.993	3.512	5.315	7.107	11.444
P值	?	>0.05	>0.05	>0.05	<0.05	<0.05	<0.05

表1 CA19-9升高组和正常组HBV相关性肝癌患者无病生存率比较（%）

组别	例数	1年	2年	3年	4年	5年	10年
CA19-9升高组	258	78.1	57.0	46.8	44.6	33.2	16.9
CA19-9正常组	296	74.7	61.1	55.3	54.4	46.8	38.7
Z值	?	1.285	0.993	3.512	5.315	7.107	11.444
P值	?	>0.05	>0.05	>0.05	<0.05	<0.05	<0.05

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Value of preoperative carbohydrate antigen 19-9 in predicting recurrence of HBV-related hepatocellular carcinoma after R0 resection

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Value of preoperative carbohydrate antigen 19-9 in predicting recurrence of HBV-related hepatocellular carcinoma after R0 resection