晚期肝癌患者血清转化生长因子β1在肝动脉化疗栓塞术前后变化及对预后的意义
| 作者: |
1刘磊,
1韩文豪,
1陈涛,
1侯国欣,
1仝现州
1 郑州人民医院 普通外科，河南 郑州450000 |
| 通讯: |
刘磊
Email: liulei_pwk@163.com |
| DOI: | 10.3978/.2018.01.015 |
摘要
目的：探讨晚期原发性肝癌（PHC）患者接受肝动脉化疗栓塞术（TACE）治疗前后转化生长因子β1（TGF-β1）水平变化及其对预后的意义。
方法：选择2012年6月—2016年1月期间在郑州人民医院进行TACE治疗的晚期PHC患者116例，检测患者术前与术后1、7、30 d时的血清TGF-β1水平，根据预后随访情况分析各时间点TGF-β1水平与PHC患者复发转移、生存期的关系。
结果：全组患者中，术后1 d的TGF-β1水平较术前明显升高，术后7、30 d则明显降低（均P<0.05）；术后复发/转移患者（75例）与无进展患者（41例）术前和术后1、7 d时的 TGF-β1水平无明显差异（均P>0.05），但术后30 d时明显高于无进展组患者（268.3 pg/mL vs. 200.4 pg/mL，P=0.001）；Kaplan-Meier生存分析显示，术前、术后30 d的TGF-β1水平以及癌灶最大直径、癌灶个数是患者生存期的影响因素（均P<0.05），多因素Cox回归分析显示术后1个月TGF-β1水平（OR=2.820，95% CI= 1.559~5.102，P=0.001）以及癌灶最大直径（OR=2.063，95% CI=1.152~3.694，P=0.015）是PHC患者的独立预后因素。
结论：TGF-β1水平变化与晚期PHC患者TACE后结局密切相关，TACE术前及术后30 d时的TGF-β1水平对预后有一定提示意义，高TGF-β1水平患者预后不良的风险大于低水平患者。
关键词：
肝肿瘤；化学栓塞，治疗性；转化生长因子β1；预后
方法：选择2012年6月—2016年1月期间在郑州人民医院进行TACE治疗的晚期PHC患者116例，检测患者术前与术后1、7、30 d时的血清TGF-β1水平，根据预后随访情况分析各时间点TGF-β1水平与PHC患者复发转移、生存期的关系。
结果：全组患者中，术后1 d的TGF-β1水平较术前明显升高，术后7、30 d则明显降低（均P<0.05）；术后复发/转移患者（75例）与无进展患者（41例）术前和术后1、7 d时的 TGF-β1水平无明显差异（均P>0.05），但术后30 d时明显高于无进展组患者（268.3 pg/mL vs. 200.4 pg/mL，P=0.001）；Kaplan-Meier生存分析显示，术前、术后30 d的TGF-β1水平以及癌灶最大直径、癌灶个数是患者生存期的影响因素（均P<0.05），多因素Cox回归分析显示术后1个月TGF-β1水平（OR=2.820，95% CI= 1.559~5.102，P=0.001）以及癌灶最大直径（OR=2.063，95% CI=1.152~3.694，P=0.015）是PHC患者的独立预后因素。
结论：TGF-β1水平变化与晚期PHC患者TACE后结局密切相关，TACE术前及术后30 d时的TGF-β1水平对预后有一定提示意义，高TGF-β1水平患者预后不良的风险大于低水平患者。
Changes in serum transforming growth factor β1 level in patients with advanced primary hepatic carcinoma before and after transcatheter arterial chemoembolization and its prognostic significance
CorrespondingAuthor:LIU Lei Email: liulei_pwk@163.com
Abstract
Objective: To investigate the changes in serum transforming growth factor β1 (TGF-β1) level in patients with advanced primary hepatic carcinoma (PHC) before and after transcatheter arterial chemoembolization (TACE) and its prognostic significance.
Methods: One-hundred and sixteen patients with advanced PHC undergoing TACE in the People’s Hospital of Zhengzhou from June 2012 to January 2016 were enrolled. The serum TGF-β1 levels of the patients were determined at 1 d before and 1, 7 and 30 d after TACE. The relations of serum TGF-β1 level with recurrence/metastasis and survival time of the patients were analyzed according to the follow-up findings and TGF-β1 level at each defined time point.
Results: In the entire group of patients, the TGF-β1 level was significantly higher at 1 d after TACE, while it was significantly lower at 7 or 30 d after TACE than that of preoperative value (all P<0.05); the TGF-β1 level in patients with postoperative recurrence/metastasis (75 cases) showed no significant difference with that in patients with progression-free survival (41 cases) at either preoperative or postoperative 1 or 7 d assessment (all P>0.05), but was significantly higher than that in patients with progression-free survival 30 d after TACE (268.3 pg/mL vs. 200.4 pg/mL, P=0.001). The results of Kaplan-Meier analysis showed that the TGF-β1 level before and 30 d after TACE along with the maximum diameter of the tumor and lesion number were the influential factors for survival time of the patients (all P<0.05), and the results of multivariate Cox regression analysis showed that the postoperative 30 d TGF-β1 level (OR=2.820, 95% CI=1.559–5.102, P=0.001) together with the maximum diameter of the tumor (OR=2.063, 95% CI=1.152–3.694, P=0.015) were the independent prognostic factors.
Conclusion: The change in TGF-β1 level is closely related to the outcomes of patients with advanced PHC after TACE. The preoperative and postoperative day 30 TGF-β1 levels have certain implications for prognosis, and patients with high TGF-β1 level may have a higher risk of poor prognosis than those with low TGF-β1 level.
Keywords：
Liver Neoplasms; Chemoembolization
Therapeutic; Transforming Growth Factor β1; Prognosis
Methods: One-hundred and sixteen patients with advanced PHC undergoing TACE in the People’s Hospital of Zhengzhou from June 2012 to January 2016 were enrolled. The serum TGF-β1 levels of the patients were determined at 1 d before and 1, 7 and 30 d after TACE. The relations of serum TGF-β1 level with recurrence/metastasis and survival time of the patients were analyzed according to the follow-up findings and TGF-β1 level at each defined time point.
Results: In the entire group of patients, the TGF-β1 level was significantly higher at 1 d after TACE, while it was significantly lower at 7 or 30 d after TACE than that of preoperative value (all P<0.05); the TGF-β1 level in patients with postoperative recurrence/metastasis (75 cases) showed no significant difference with that in patients with progression-free survival (41 cases) at either preoperative or postoperative 1 or 7 d assessment (all P>0.05), but was significantly higher than that in patients with progression-free survival 30 d after TACE (268.3 pg/mL vs. 200.4 pg/mL, P=0.001). The results of Kaplan-Meier analysis showed that the TGF-β1 level before and 30 d after TACE along with the maximum diameter of the tumor and lesion number were the influential factors for survival time of the patients (all P<0.05), and the results of multivariate Cox regression analysis showed that the postoperative 30 d TGF-β1 level (OR=2.820, 95% CI=1.559–5.102, P=0.001) together with the maximum diameter of the tumor (OR=2.063, 95% CI=1.152–3.694, P=0.015) were the independent prognostic factors.
Conclusion: The change in TGF-β1 level is closely related to the outcomes of patients with advanced PHC after TACE. The preoperative and postoperative day 30 TGF-β1 levels have certain implications for prognosis, and patients with high TGF-β1 level may have a higher risk of poor prognosis than those with low TGF-β1 level.