切换至 "中华医学电子期刊资源库"
高级检索
中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2019, Vol. 08 ›› Issue (03) : 256 -259. doi: 10.3877/cma.j.issn.2095-3232.2019.03.018

所属专题： 文献；

临床研究

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
周三顺1, 王祖森2, 李满江1, 朱呈瞻2, 曺景玉2, 吴力群1,†()   
  1. 1. 266003　青岛大学附属医院肝脏病中心
    2. 266003　青岛大学附属医院肝胆胰外科
  • 收稿日期:2019-03-18 出版日期:2019-06-10
  • 通信作者: 吴力群
  • 基金资助:
    国家自然科学基金青年科学基金(81600490)

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

Sanshun Zhou1, Zusen Wang2, Manjiang Li1, Chengzhan Zhu2, Jingyu Cao2, Liqun Wu1,†()   

  1. 1. Department of Liver Disease Center, the Affiliated Hospital of Qingdao University, Qingdao 266003, China
    2. Department of Hepatobiliary and Pancreatic Surgery, the Affiliated Hospital of Qingdao University, Qingdao 266003, China
  • Received:2019-03-18 Published:2019-06-10
  • Corresponding author: Liqun Wu
  • About author:
    Corresponding author: Wu Liqun, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

周三顺, 王祖森, 李满江, 朱呈瞻, 曺景玉, 吴力群. 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[J]. 中华肝脏外科手术学电子杂志, 2019, 08(03): 256-259.

Sanshun Zhou, Zusen Wang, Manjiang Li, Chengzhan Zhu, Jingyu Cao, Liqun Wu. Prognostic value of serum CA125 in hepatocellular carcinoma patients with low level of AFP after R0 resection[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2019, 08(03): 256-259.

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
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
[1]
Bray F,Ferlay J,Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6): 394-424.
[2]
Feng X,Su Y,Zheng S, et al. A double blinded prospective randomized trial comparing the effect of anatomic versus non-anatomic resection on hepatocellular carcinoma recurrence[J]. HPB, 2017, 19(8):667-674.
[3]
Nakao K,Ichikawa T. Recent topics on alpha-fetoprotein[J]. Hepatol Res, 2013, 43(8):820-825.
[4]
Song PP,Xia JF,Inagaki Y, et al. Controversies regarding and perspectives on clinical utility of biomarkers in hepatocellular carcinoma[J]. World J Gastroenterol, 2016, 22(1):262-274.
[5]
Bocheva Y,Bochev P,Ivanov S. Ca-125 in diagnosis and monitoring of patients with ovarian cancer[J]. Akush Ginekol, 2015, 54(1):11-17.
[6]
Gasiorowska E,Michalak M,Warchol W, et al. Clinical application of HE4 and CA125 in ovarian cancer type I and type II detection and differential diagnosis[J]. Ginekol Pol, 2015, 86(2):88-93.
[7]
Terentiev AA,Moldogazieva NT. Alpha-fetoprotein: a renaissance[J]. Tumour Biol, 2013, 34(4):2075-2091.
[8]
European Association For The Study Of The Liver, European Organisation For Research And Treatment Of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma[J]. J Hepatol, 2012, 56(4):908-943.
[9]
Park SJ,Jang JY,Jeong SW, et al. Usefulness of AFP, AFP-L3, and PIVKA-II, and their combinations in diagnosing hepatocellular carcinoma[J]. Medicine, 2017, 96(11):e5811.
[10]
Tao LP,Fan XP,Fan YC, et al. Combined detection of insulin-like growth factor-binding protein 7 promoter methylation improves the diagnostic efficacy of AFP in hepatitis B virus-associated hepatocellular carcinoma[J]. Pathol Res Pract, 2018, 214(1):144-150.
[11]
Diamandis EP,Bast RC Jr,Gold P, et al. Reflection on the discovery of carcinoembryonic antigen, prostate-specific antigen, and cancer antigens CA125 and CA19-9[J]. Clin Chem, 2013, 59(1):22-31.
[12]
O'Brien TJ,Beard JB,Underwood LJ, et al. The CA 125 gene: an extracellular superstructure dominated by repeat sequences[J]. Tumour Biol, 2001, 22(6):348-366.
[13]
Comamala M,Pinard M,Theriault C, et al. Downregulation of cell surface CA125/MUC16 induces epithelial-to-mesenchymal transition and restores EGFR signalling in NIH: OVCAR3 ovarian carcinoma cells[J]. Br J Cancer, 2011, 104(6):989-999.
[14]
Pradjatmo H,Pradjatmo H. Impact of preoperative serum levels of CA 125 on epithelial ovarian cancer survival[J]. Asian Pac J Cancer Prev, 2016, 17(4):1881-1886.
[15]
Isaksson S,Jonsson P,Monsef N, et al. CA 19-9 and CA 125 as potential predictors of disease recurrence in resectable lung adenocarcinoma[J]. PLoS One, 2017, 12(10):e0186284.
[16]
Liang C,Qin Y,Zhang B, et al. Oncogenic KRAS targets MUC16/CA125 in pancreatic ductal adenocarcinoma[J]. Mol Cancer Res, 2017, 15(2):201-212.
[17]
Rachagani S,Torres MP,Kumar S, et al. Mucin (Muc) expression during pancreatic cancer progression in spontaneous mouse model: potential implications for diagnosis and therapy[J]. J Hematol Oncol, 2012(5):68.
[18]
Farag S,Nguyen L,Kalir T, et al. Endometriosis presenting with massive ascites and an elevated CA-125[J]. J Minim Invasive Gynecol, 2015, 22(6S):S171-172.
[19]
Cheng DL,Xu H,Lv WF, et al. The significance of serum CA-125 elevation in Chinese patients with primary Budd-Chiari syndrome: a multicenter study[J]. Gastroenterol Res Pract, 2015: 121060.
[20]
Wang Y,Han C,Teng F, et al. Predictive value of serum HE4 and CA125 concentrations for lymphatic metastasis of endometrial cancer[J]. Int J Gynaecol Obstet, 2017, 136(1):58-63.
[1] 应康, 杨璨莹, 刘凤珍, 陈丽丽, 刘燕娜. 左心室心肌应变对无症状重度主动脉瓣狭窄患者的预后评估价值[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 581-587.
[2] 李越洲, 张孔玺, 李小红, 商中华. 基于生物信息学分析胃癌中PUM的预后意义[J]. 中华普通外科学文献(电子版), 2023, 17(06): 426-432.
[3] 张俊, 罗再, 段茗玉, 裘正军, 黄陈. 胃癌预后预测模型的研究进展[J]. 中华普通外科学文献(电子版), 2023, 17(06): 456-461.
[4] 杨倩, 李翠芳, 张婉秋. 原发性肝癌自发性破裂出血急诊TACE术后的近远期预后及影响因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 33-36.
[5] 栗艳松, 冯会敏, 刘明超, 刘泽鹏, 姜秋霞. STIP1在三阴性乳腺癌组织中的表达及临床意义研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 52-56.
[6] 马伟强, 马斌林, 吴中语, 张莹. microRNA在三阴性乳腺癌进展中发挥的作用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 111-114.
[7] 杜锡林, 谭凯, 贺小军, 白亮亮, 赵瑶瑶. 肝细胞癌转化治疗方式[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 597-601.
[8] 魏小勇. 原发性肝癌转化治疗焦点问题探讨[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 602-607.
[9] 潘冰, 吕少诚, 赵昕, 李立新, 郎韧, 贺强. 淋巴结清扫数目对远端胆管癌胰十二指肠切除手术疗效的影响[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 608-612.
[10] 张其坤, 商福超, 李琪, 栗光明, 王孟龙. 联合脾切除对肝癌合并门静脉高压症患者根治性切除术后的生存获益分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 613-618.
[11] 严庆, 刘颖, 邓斐文, 陈焕伟. 微血管侵犯对肝癌肝移植患者生存预后的影响[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 624-629.
[12] 张文华, 陶焠, 胡添松. 不同部位外生型肝癌临床病理特点及其对术后肝内复发和预后影响[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 651-655.
[13] 李永胜, 孙家和, 郭书伟, 卢义康, 刘洪洲. 高龄结直肠癌患者根治术后短期并发症及其影响因素[J]. 中华临床医师杂志(电子版), 2023, 17(9): 962-967.
[14] 王军, 刘鲲鹏, 姚兰, 张华, 魏越, 索利斌, 陈骏, 苗成利, 罗成华. 腹膜后肿瘤切除术中大量输血患者的麻醉管理特点与分析[J]. 中华临床医师杂志(电子版), 2023, 17(08): 844-849.
[15] 索利斌, 刘鲲鹏, 姚兰, 张华, 魏越, 王军, 陈骏, 苗成利, 罗成华. 原发性腹膜后副神经节瘤切除术麻醉管理的特点和分析[J]. 中华临床医师杂志(电子版), 2023, 17(07): 771-776.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号