超声造影结合异常凝血酶原Ⅱ预测老年肝细胞癌患者TACE术后非完全缓解的价值探讨

Value of contrastation-enhanced ultrasound combined with abnormal prothrombin Ⅱ in predicting incomplete response after TACE in elderly patients with hepatocellular carcinoma

摘要:

目的 探讨超声造影结合异常凝血酶原Ⅱ（PIVKA-Ⅱ）预测老年肝细胞癌患者经动脉化疗栓塞（TACE）术后非完全缓解（CR）的价值。方法 选取2019年5月—2022年3月太原钢铁集团有限公司总医院收治的97例老年肝细胞癌患者为研究对象。患者接受TACE术治疗，术后7 d测定血清PIVKA-Ⅱ水平，术后3个月接受超声造影检查。根据患者TACE术后疗效情况分为CR组与非CR组。比较两组超声造影特征、血清PIVKA-Ⅱ水平及临床资料。采用多因素逐步Logistic回归模型分析老年肝细胞癌患者TACE术后非CR的影响因素。绘制受试者工作特征（ROC）曲线，以曲线下面积（AUC）评估超声造影结合PIVKA-Ⅱ的预测价值。结果 术后3个月，97例患者中33例CR，发生率34.02%，64例非CR，发生率65.98%。非CR组动脉期增强率、延迟期增强率、门静脉期增强率高于CR组（P <0.05）。非CR组肿瘤直径>5 cm例数占比高于CR组（P <0.05）。多因素逐步Logistic回归分析结果显示，动脉期增强［O^R=3.480（95% CI：1.530，7.916）］、延迟期增强［O^R=4.293（95% CI：1.887，9.766）］、门静脉期增强［O^R=2.726（95% CI：1.199，6.202）］、血清PIVKA-Ⅱ升高［O^R=3.050（95% CI：1.341，6.937）］、肿瘤直径> 5 cm［O^R=3.575（95% CI：1.572，8.133）］为老年肝细胞癌患者TACE术后非CR的影响因素（P <0.05）。ROC曲线分析结果显示，超声造影、血清PIVKA-Ⅱ单独及联合预测老年肝细胞癌患者TACE术后非CR的敏感性分别为84.37%（95% CI：0.627，0.895）、78.56%（95% CI：0.569，0.834）、92.19%（0.702，0.958），特异性分别为60.61%（95% CI：0.523，0.731）、78.79%（95% CI：0.583，0.852）、84.85%（95% CI：0.627，0.920），AUC分别为0.725（95% CI：0.625，0.811）、0.760（95% CI：0.663，0.841）、0.885（95% CI：0.804，0.942）（P <0.05），二者联合时AUC更高。结论 超声造影、血清PIVKA-Ⅱ在预测老年肝细胞癌患者TACE术后非CR中具有重要价值，且二者联合预测价值更高。

Abstract:

Objective To investigate the value of contrast-enhanced ultrasonography (CEUS) combined with abnormal prothrombin Ⅱ (PIVKA-Ⅱ) in predicting post-transarterial chemoembolization (TACE) incomplete response (CR) in elderly hepatocellular carcinoma (HCC) patients.Methods A total of 97 elderly HCC patients treated at Taiyuan Iron and Steel Group General Hospital from May 2019 to March 2022 were selected. The patients underwent TACE treatment, and serum PIVKA-Ⅱ levels were measured at 7 days after the operation. CEUS examination was performed at 3 months after the operation. According to the post-TACE therapeutic response, the patients were divided into CR group and non-CR group. The CEUS characteristics, serum PIVKA-Ⅱ levels, and clinical data of the two groups were compared. Multivariate stepwise logistic regression analysis was used to analyze the influencing factors of post-TACE incomplete response in elderly HCC patients. Receiver operating characteristic (ROC) curves were drawn to evaluate the predictive value of CEUS combined with PIVKA-Ⅱ.Results At 3 months after the operation, among the 97 patients, 33 cases achieved CR, with an incidence rate of 34.02%, and 64 cases did not achieve CR, with an incidence rate of 65.98%. The non-CR group had higher arterial phase enhancement rate, delayed phase enhancement rate, and portal vein phase enhancement rate than the CR group (P < 0.05). The proportion of tumors with diameter >5 cm in the non-CR group was higher than that in the CR group (P < 0.05). Multivariate stepwise logistic regression analysis showed that arterial phase enhancement [O^R = 3.480 (95% CI: 1.530, 7.916)], delayed phase enhancement [O^R = 4.293 (95% CI: 1.887, 9.766)], portal vein phase enhancement [O^R = 2.726 (95% CI: 1.199, 6.202)], elevated serum PIVKA-Ⅱ [O^R = 3.050 (95% CI: 1.341, 6.937)], and tumor diameter > 5 cm [O^R = 3.575 (95% CI: 1.572, 8.133)] were influencing factors for post-TACE incomplete response in elderly HCC patients (P < 0.05). ROC curve analysis showed that CEUS, serum PIVKA-Ⅱ alone, and combined prediction of post-TACE incomplete response in elderly HCC patients had sensitivities of 84.37% (95% CI: 0.627, 0.895), 78.56% (95% CI: 0.569, 0.834), and 92.19% (0.702, 0.958), respectively, and specificities of 60.61% (95% CI: 0.523, 0.731), 78.79% (95% CI: 0.583, 0.852), and 84.85% (95% CI: 0.627, 0.920), respectively, with AUCs of 0.725 (95% CI: 0.625, 0.811), 0.760 (95% CI: 0.663, 0.841), and 0.885 (95% CI: 0.804, 0.942) (P < 0.05), and the combined prediction had a higher AUC.Conclusion CEUS and serum PIVKA-Ⅱ have important value in predicting post-TACE incomplete response in elderly HCC patients, and the predictive value of the combination of the two is higher.