中国普外基础与临床杂志

中国普外基础与临床杂志

肝细胞性肝癌组织中甲胎蛋白的表达对化疗耐药的预测价值

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目的 评估肝细胞性肝癌组织中甲胎蛋白(AFP)的表达与化疗耐药的关系。 方法 从肝动脉插管栓塞化疗前行穿刺取得的肝脏肿瘤组织样本中筛选出肝细胞性肝癌,应用免疫组织化学染色方法检测 HCC 组织中 AFP 的表达,分析 HCC 组织中 AFP 的表达对患者化疗效果的影响。 结果 共有 62 例患者符合入组标准,其中化疗耐药组 36 例,化疗敏感组 26 例;HCC 组织中 AFP 表达阳性者 42 例(包括化疗耐药者 29 例),表达阴性者 20 例(包括化疗耐药者 7 例)。2 组患者在性别、年龄、肿瘤分化程度、肝功能 Child-Pugh 分级、肿瘤大小、肿瘤部位以及是否合并肝炎方面之间的差异均无统计学意义 (P>0.05);而在患者血清 AFP 水平升高、肿瘤单发以及合并门静脉癌栓方面,化疗敏感组的患者占比显著低于化疗耐药组(P<0.05)。多因素分析结果提示,肿瘤组织中 AFP 表达阳性[OR=0.280,95%CI 为(0.092,0.950),P=0.045]和门静脉癌栓[OR=0.026, 95%CI 为(0.004,0.322),P=0.005]是 HCC 化疗耐药的独立危险因素。 结论 肝脏肿瘤组织 AFP 表达阳性以及门静脉癌栓能够较好地预测患者的化疗耐药。

Objective To evaluate the relationship between the expression of alpha fetoprotein (AFP) and chemoresistance in hepatocellular carcinoma. Methods Hepatocellular carcinoma was screened from liver tumor tissue samples, which was obtained by puncture before transcatheter arterial chemoembolization (TACE). Immunohistochemical staining was used to detect the expression of AFP in HCC tissues and the effect of AFP expression in HCC on the effect of chemotherapy was analyzed. Results A total of 62 patients met the inclusion criteria, of which 36 were in the chemotherapy resistant group and 26 in the chemotherapy sensitive group. There were 42 patients with positive expression of AFP in tumor tissues (including 29 patients with chemoresistance) and 20 patients with negative expression of AFP in tumor tissues (including 7 patients with chemoresistance). There were no significant difference between the two groups in sex, age, tumor differentiation, Child-Pugh classification of liver function, tumor size, tumor site and hepatitis (P>0.05). In elevated serum AFP level, tumor single, and with portal vein tumor thrombus (PVTT), the proportion of patients in the chemosensitivity group were significantly lower than that in the chemosensitivity group (P<0.05). The results of logistic multivariate regression analysis showed that positive expression of AFP [OR=0.280,95%CI (0.092, 0.950), P=0.045] and PVTT [OR=0.026, 95%CI (0.004, 0.322), P=0.005] were independent risk factors for chemotherapeutic resistance in hepatocellular carcinoma. Conclusion AFP positive expression in liver tumor tissues and PVTT are useful indicators of resistance to chemotherapy.

关键词: 肝细胞性肝癌; 甲胎蛋白; 化疗耐药

Key words: Hepatocellular carcinoma; Alpha fetoprotein; Chemotherapeutic resistance

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