肿瘤组织VEGF、CD34表达联合LSM水平预测肝癌患者术后复发的价值

Predictive value of expressions of VEGF and CD34 in tumor tissues combined with LSM results for postoperative recurrence of hepatocellular carcinoma

摘要:

目的 探讨肿瘤组织血管内皮细胞生长因子（VEGF）、CD34表达联合肝硬度值（LSM）水平预测肝癌患者术后复发的价值。方法 选取2018年1月—2022年1月在无锡市第九人民医院治疗的原发性肝癌患者102例，术后随访有44例患者复发（复发组），58例患者未复发（未复发组），分析不同临床特征患者VEGF、CD34表达及LSM差异，同时分析复发组与未复发组患者临床特征、VEGF、CD34表达及LSM差异，建立方程预测肝癌患者术后复发并评估。结果 病理分期Ⅲ期患者VEGF和CD34阳性表达率高于Ⅰ、Ⅱ期患者（P <0.05）；低分化患者VEGF和CD34阳性表达率高于中高分化患者（P <0.05）。肿瘤最大直径 ≥ 5 cm、肝功能分级B级、有血管癌栓、病理分期Ⅲ期、低分化患者LSM水平分别高于肿瘤最大直径 < 5 cm、肝功能分级A级、无血管癌栓、病理分期Ⅰ、Ⅱ期、中高分化患者（P <0.05）。复发组有血管癌栓、病理分期Ⅲ期、低分化、VEGF和CD34阳性表达率均高于未复发组（P <0.05）；复发组LSM水平高于未复发组（P <0.05）。多因素一般Logistic回归分析，结果显示：血管癌栓［O^R=1.943（95% CI：1.305，2.892）］、病理分期［O^R=2.807（95% CI：1.453，5.423）］、VEGF表达［O^R=2.063（95% CI：1.330，3.200）］、CD34表达［O^R=2.228（95% CI：1.514，3.278）］和LSM［O^R=1.944（95% CI：1.345，2.811）］是肝癌患者术后复发的影响因素（P <0.05）。Logit（P）=0.664×血管癌栓+1.032×病理分期+0.724×VEGF表达+0.801×CD34表达+0.665×LSM-3.320预测肝癌患者术后复发的敏感性、特异性分别为75.00%（95% CI：0.632，0.868）和79.30%（95% CI：0.665，0.896）。结论 肿瘤组织VEGF、CD34表达及LSM水平与肝癌患者临床病理特征及术后复发有关，在预测患者术后复发方面有一定应用价值。

Abstract:

Objective To explore the value of the expressions of vascular endothelial growth factor (VEGF) and CD34 in tumor tissues combined with liver stiffness measurement (LSM) results in predicting postoperative recurrence of hepatocellular carcinoma.Methods A total of 102 patients with primary hepatocellular carcinoma who were treated in Wuxi Ninth People's Hospital from January 2018 to January 2022 were selected for postoperative follow-up, of which 44 patients experienced recurrence (recurrence group) and 58 patients did not (non-recurrence group). The differences in expressions of VEGF and CD34 as well as the LSM results were analyzed among patients with distinct clinical characteristics. Meanwhile, the discrepancies in clinical features, expressions of VEGF and CD34, and LSM results between patients in the recurrence group and those in the non-recurrence group were also analyzed. The model for predicting postoperative recurrence of hepatocellular carcinoma was established and its predictive value was assessed.Results The positive expression rates of VEGF and CD34 in patients with stage III tumors were significantly higher than those in patients with stage I and II tumors (P < 0.05), and they were higher in patients with poorly-differentiated tumors than those in patients with moderately- and well-differentiated tumors (P < 0.05). The liver stiffness of patients with tumors≥ 5 cm in maximum diameter, Child-Pugh class B, presence of intravascular tumor thrombus, stage III tumors, and poorly-differentiated tumors was higher than that of patients with tumors < 5 cm in maximum diameter, Child-Pugh class A, absence of intravascular tumor thrombus, stage I and II tumors, and moderately- and well-differentiated tumors, respectively (P < 0.05). The proportions of patients with the presence of intravascular tumor thrombus, stage III tumors, poorly-differentiated tumors, and positive expressions of VEGF and CD34 in the recurrence group were significantly higher than those in the non-recurrence group (P < 0.05), while liver stiffness of patients in the recurrence group was higher than that of patients in the non-recurrence group (P < 0.05). Multivariable Logistic regression analysis revealed that presence of intravascular cancer thrombus [O^R = 1.943 (95% CI: 1.305, 2.892) ], pathological stages of tumors [O^R =2.807 (95% CI: 1.453, 5.423) ], the expression of VEGF [O^R = 2.063 (95% CI: 1.330, 3.200) ], the expression of CD34 [O^R = 2.228 (95% CI: 1.514, 3.278) ], and LSM results [O^R = 1.944 (95% CI: 1.345, 2.811) ] were factors affecting postoperative recurrence of hepatocellular carcinoma (P < 0.05), with the model established as Logit (P) = 0.664 × presence of intravascular cancer thrombus + 1.032 × pathological stages of tumors + 0.724 × the expression of VEGF + 0.801 × the expression of CD34 + 0.665 × LSM results - 3.320. The sensitivity and specificity of the model for predicting postoperative recurrence of hepatocellular carcinoma were 75.00% (95% CI: 0.632, 0.868) and 79.30% (95% CI: 0.665, 0.896), respectively.Conclusions The expressions of VEGF and CD34 in tumor tissues as well as LSM results are related to the clinicopathological characteristics and postoperative recurrence of hepatocellular carcinoma, and are of value in predicting postoperative recurrence of hepatocellular carcinoma.