血清CA125在低水平AFP肝细胞癌R0切除术后患者中的预后价值

doi:10.3877/cma.j.issn.2095-3232.2019.03.018

目的

探讨术前血清癌抗原（CA）125在低水平AFP肝细胞癌（HCC）R0切除术后患者中的预后价值。

方法

回顾性分析2009年1月至2015年12月青岛大学附属医院行R0切除术的427例HCC患者临床资料。其中男366例，女61例；平均年龄（57±10）岁；AFP≤200 μg/L。患者均签署知情同意书，符合医学伦理学规定。所有患者术前均检测血清CA125及AFP水平。根据患者血清水平，将患者分为CA125正常组（392例）和CA125升高组（35例）。血清CA125水平的影响因素分析采用χ²检验，生存分析采用Kaplan-Meier法和Log-rank检验。

结果

术前血清CA125升高在女性和肿瘤最大直径>5 cm患者中比例明显升高（χ²=4.067，29.006；P<0.05）。CA125正常组和CA125升高组患者1、2、5年无瘤生存率分别为84.9%、69.9%、43.9%和61.8%、49.7%、16.5%，CA125正常组无瘤生存明显优于CA125升高组（χ²=8.593，P<0.05）；1、2、5年总体生存率相应为97.4%、90.6%、67.2%和91.4%、65.7%、44.5%，CA125正常组总体生存亦明显优于CA125升高组（χ²=10.478，P<0.05）。

结论

术前血清CA125水平升高是低水平AFP的HCC R0切除术后患者高复发率及低生存率的预测指标，CA125水平的升高与性别和肿瘤直径有关。

关键词: 癌，肝细胞, 癌抗原125, 甲胎蛋白类, 预后

Objective

To investigate the prognostic value of preoperative serum level of cancer antigen (CA) 125 in hepatocellular carcinoma (HCC) patients with a low level of AFP after R0 resection.

Methods

Clinical data of 427 HCC patients who underwent R0 resection in the Affiliated Hospital of Qingdao University from January 2009 to December 2015 were retrospectively analyzed. Among them, 366 patients were male and 61 female, aged (57±10) years on average, with AFP≤200 μg/L. The informed consents of all patients were obtained and the local ethical committee approval was received. The serum levels of CA125 and AFP were detected in all patients before operation. According to the level of CA125, all patients were divided into normal CA125 (n=392) and elevated CA125 groups (n=35). The factors affecting preoperative serum level of CA125 were analyzed by Chi-square test. The survival analysis was performed by Kaplan-Meier method and Log-rank test.

Results

The proportion of elevated CA125 before operation in women and patients with maximum tumor diameter >5 cm significantly increased (χ²=4.067, 29.006; P<0.05). The 1-, 2-, and 5-year tumor-free survival rates in normal CA125 group were 84.9%, 69.9%, 43.9%, and 61.8%, 49.7%, 16.5% in elevated CA125 group. The tumor-free survival of normal CA125 group was significantly better compared with that of elevated CA125 group (χ²=8.593, P<0.05). The 1-, 2-, and 5-year overall survival rates in normal CA125 group were 97.4%, 90.6%, 67.2%, and 91.4%, 65.7%, 44.5% in elevated CA125 group, accordingly. The overall survival of normal CA125 group was significantly better compared with that of elevated CA125 group (χ²=10.478, P<0.05).

Conclusions

The elevation of preoperative CA125 is a predictor of high recurrence rate and low survival in HCC patients with a low level of AFP after R0 resection. The elevation of CA125 is correlated with gender and tumor diameter.

Key words: Carcinoma, hepatocellular, CA125, alpha-Fetoproteins, Prognosis

表1 CA125不同水平与患者临床病理因素的关系（例）

因素	CA125正常组	CA125升高组	χ²值	P值
年龄（≤65/>65岁）	325/67	31/4	0.743	<0.389
性别（男/女）	340/52	26/9	4.067	<0.044
酗酒（无/有）	222/170	22/13	0.508	<0.476
糖尿病（无/有）	335/57	30/5	0.002	<0.967
肝硬化（无/有）	57/335	4/31	0.254	<0.614
病毒性肝炎（无/HBV/HCV/HBV+HCV）	52/332/8/0	8/27/0/0	-	<0.219
ALT（≤60/>60 U/L）	323/69	30/5	0.274	<0.619
TB（≤20/>20 μmol/L）	304/88	26/9	0.195	<0.659
Child-Pugh分级（A/B级）	383/9	32/3	2.620	<0.106
解剖性切除（否/是）	262/130	19/16	2.249	<0.134
手术切缘（≤10/>10 mm）	335/57	29/6	0.173	<0.677
出血量（≤200/>200 ml）	227/165	16/19	1.948	<0.163
入肝血流阻断（无/有）	199/193	22/13	1.882	<0.170
肿瘤最大直径（≤5/>5 cm）	307/85	13/22	29.006	<0.001
肿瘤数目（单发/多发）	332/60	31/4	0.379	<0.538
肉眼血管侵犯（无/有）	377/15	34/1	0.084	<0.772
微血管侵犯（无/有）	310/82	26/9	0.441	<0.507
组织学分化（高/中、低、坏死）	48/344	2/33	1.325	0.250

表1 CA125不同水平与患者临床病理因素的关系（例）

因素	CA125正常组	CA125升高组	χ²值	P值
年龄（≤65/>65岁）	325/67	31/4	0.743	<0.389
性别（男/女）	340/52	26/9	4.067	<0.044
酗酒（无/有）	222/170	22/13	0.508	<0.476
糖尿病（无/有）	335/57	30/5	0.002	<0.967
肝硬化（无/有）	57/335	4/31	0.254	<0.614
病毒性肝炎（无/HBV/HCV/HBV+HCV）	52/332/8/0	8/27/0/0	-	<0.219
ALT（≤60/>60 U/L）	323/69	30/5	0.274	<0.619
TB（≤20/>20 μmol/L）	304/88	26/9	0.195	<0.659
Child-Pugh分级（A/B级）	383/9	32/3	2.620	<0.106
解剖性切除（否/是）	262/130	19/16	2.249	<0.134
手术切缘（≤10/>10 mm）	335/57	29/6	0.173	<0.677
出血量（≤200/>200 ml）	227/165	16/19	1.948	<0.163
入肝血流阻断（无/有）	199/193	22/13	1.882	<0.170
肿瘤最大直径（≤5/>5 cm）	307/85	13/22	29.006	<0.001
肿瘤数目（单发/多发）	332/60	31/4	0.379	<0.538
肉眼血管侵犯（无/有）	377/15	34/1	0.084	<0.772
微血管侵犯（无/有）	310/82	26/9	0.441	<0.507
组织学分化（高/中、低、坏死）	48/344	2/33	1.325	0.250

图1 CA125正常组和CA125升高组患者无瘤生存和总体生存Kaplan-Meier曲线

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Prognostic value of serum CA125 in hepatocellular carcinoma patients with low level of AFP after R0 resection

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Prognostic value of serum CA125 in hepatocellular carcinoma patients with low level of AFP after R0 resection