摘要
目的探究术前血清hsa_circ_0005397、甲胎蛋白(AFP)与癌胚抗原(CEA)预测肝细胞癌(HCC)术后早期复发的临床价值。方法纳入2020年1月至2023年6月于如皋市中医院行腹腔镜下HCC根治性切除术的患者125例。依据术后早期(<2年)复发与否分为复发组与未复发组,对比两组一般资料、肿瘤信息、术前血清相关指标等。Logistic回归分析HCC术后早期复发的危险因素,据此构建预测模型,通过受试者工作特征(ROC)曲线分析血清hsa_circ_0005397、AFP、CEA水平对早期复发的预测价值,通过Spearman相关分析,探讨has-circ-005397与临床病理特征的相关性。结果125例HCC患者术后早期复发率为36.00%。复发组乙型肝炎病毒(HBV)-DNA≥500 Iku/L、肿瘤大小≥5 cm、卫星结节、BCLC分期B、C期、微血管侵犯(MVI)率及术前血清hsa_circ_0005397、AFP、CEA水平均显著高于未复发组(P<0.05)。Logistic回归分析表明MVI(OR=16.650)、血清高hsa_circ_0005397(OR=68.856)、AFP(OR=1.014)、CEA(OR=1.463)水平是影响HCC术后早期复发的独立危险因素(P<0.05)。依据Logistic回归分析获取的独立影响因素构建HCC术后早期复发风险模型(P)=-15.866+2.736×MVI+3.215×hsa_circ_0005397+0.011×AFP+0.408×CEA,其预测早期复发的曲线下面积(AUC)为0.941;Hosmer-Lemeshowχ2=6.345,P>0.05;决策曲线分析可见阈概率(红线)分布在None与All线右上方。ROC曲线可见,术前血清hsa_circ_0005397、AFP、CEA及其联合预测术后早期复发的AVC分别为0.864、0.870、0.753、0.930。术前血清hsa_circ_0005397与肿瘤大小、BCLC分期、MVI均正相关(均P<0.001)。结论术前血清hsa_circ_0005397、AFP、CEA对HCC术后早期复发均有一定的预测价值,特别是联合检测,预测效能更佳,且基于术前血清指标及MVI构建的风险预测模型区分度、校准能力及临床实用性均较好。
Objective To explore the clinical value of preoperative serum hsa_circ_0005397,alpha-fetoprotein(AFP)and carcinoembryonic antigen(CEA)in predicting the early recurrence after hepatocellular carcinoma(HCC)surgery.Methods A total of 125 patients who underwent laparoscopic radical resection of HCC in Rugao Hospital of Traditional Chinese Medicine from January 2020 to June 2023 were included.According to with or without recurrence in the early postoperative period(<2 years),they were divided into the recurrence group and the non-recurrence group.The general information,tumor information,and preoperative serum-related indicators of the two groups were compared.Logistic regression was used to analyze the risk factors for early recurrence after HCC surgery.Based on this,a prediction model was constructed,and the predictive value of serum hsa_circ_0005397,AFP,and CEA levels for early recurrence was analyzed through the receiver operating characteristic(ROC)curve.Spearman correlation coefficient analysis was performed to explore the relationship between hsa-circ-005397 level and clinical pathological characteristios.Results The early postoperative recurrence rate of 125 HCC patients was 36%.The levels of hepatitis B virus(HBV)-DNA≥500 Iku/L,the tumor size≥5 cm,satellite nodules,BCLC stage B-C,microvascular invasion(MVI)rate,and preoperative serum hsa_circ_0005397,AFP and CEA levels in the recurrence group were significantly greater than those in the non-recurrence group(P<0.05).Logistic regression analysis showed that the levels of MVI(OR=16.650),high serum hsa_circ_0005397(OR=68.856),AFP(OR=1.014),and CEA(OR=1.463)were independent risk factors affecting the early recurrence after HCC surgery(P<0.05).The risk model of early recurrence after HCC surgery was constructed based on the independent influencing factors obtained from Logistic regression analysis(P)=-15.866+2.736×MVI+3.215×hsa_circ_0005397+0.011×AFP+0.408×CEA,and its area under the curve(AUC)for predicting early recurrence was 0.941.Hosmer-Lemeshowχ2=6.345,P>0.05;Decision curve analysis showed that the threshold probability(red line)was distributed to the upper right of the None and All lines.The ROC curve showed that the AVC of preoperative serum hsa_circ_0005397,AFP,CEA and their combination for predicting early postoperative recurrence were 0.864,0.870,0.753 and 0.930,respectively.Preoperative serum hsa_circ_0005397 was positively correlated with tumor size,BCLC stage and MVI(all P<0.001).Conclusions Preoperative serum hsa_circ_0005397,AFP and CEA all have certain predictive values for the early recurrence after HCC surgery.Especially the combined detection has a better predictive efficacy.Moreover,the risk prediction model constructed based on preoperative serum indicators and MVI has good discrimination,calibration ability and clinical practicability.
作者
谢翠华
谢慧琴
江妍
宗薇薇
范美晨
孙艳
陈文娟
XIE Cuihua;XIE Huiqin;JIANG Yan;ZONG Weiwei;FAN Meichen;SUN Yan;CHEN Wenjuan(Department of Laboratory Medicine,Rugao Hospital of Traditional Chinese Medicine,Nantong 226500,China)
出处
《中国肿瘤外科杂志》
2025年第6期603-609,共7页
Chinese Journal of Surgical Oncology
基金
南通市自然科学基金和社会民生科技计划项目(MSZ2023127)。
