异常凝血酶原联合甲胎蛋白评价原发性肝癌TACE治疗价值
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摘要
TACE是肝癌非手术切除最常用的治疗方法之一。目前,原发性肝癌(PHC)患者TACE治疗的评估主要依靠影像学检查且仍存在诸多局限性,结合特定的血清肿瘤标志物可弥补这种局限性。研究表明血清肿瘤标志物的下降程度与mRECIST标准强相关,如异常凝血酶原(PIVKA-Ⅱ,protein induced by vitamin K antagonist-Ⅱ, abnormal prothrombin)、甲胎蛋白(AFP)。本文就PIVKA-Ⅱ联合AFP在原发性肝癌患者TACE治疗的疗效及预后评价价值方面进行论述。
Transcatheter arterial chemoembolization(TACE) has been one of the most commonly used methods in the treatment of liver cancer. At present, the evaluation of TACE effect in patients with primary hepatocellular carcinoma(PHC) mainly depends on imaging examination, but there are still many limitations in imaging examination. Imaging examination combined with specific serum tumor markers can compensate for this limitation. Researches have indicated that the decrease of serum tumor markers, such as abnormal prothrombin(PIVKA-Ⅱ, protein induced by vitamin K antagonist-Ⅱ), alpha-fetoprotein(AFP), etc. is strongly correlated with the mRECIST standard. But so far, in mainland of China the use of PIVKA-Ⅱ in the clinical diagnosis and treatment of liver cancer has not comprehensively developed, especially in the interventional field. This article aims to make a comprehensive review about the value of PIVKA-Ⅱ combined with AFP in assessing the curative effect and prognosis of patients with PHC after TACE treatment.(J Intervent Radiol, 2019, 28: 591-594)
Transcatheter arterial chemoembolization(TACE) has been one of the most commonly used methods in the treatment of liver cancer. At present, the evaluation of TACE effect in patients with primary hepatocellular carcinoma(PHC) mainly depends on imaging examination, but there are still many limitations in imaging examination. Imaging examination combined with specific serum tumor markers can compensate for this limitation. Researches have indicated that the decrease of serum tumor markers, such as abnormal prothrombin(PIVKA-Ⅱ, protein induced by vitamin K antagonist-Ⅱ), alpha-fetoprotein(AFP), etc. is strongly correlated with the mRECIST standard. But so far, in mainland of China the use of PIVKA-Ⅱ in the clinical diagnosis and treatment of liver cancer has not comprehensively developed, especially in the interventional field. This article aims to make a comprehensive review about the value of PIVKA-Ⅱ combined with AFP in assessing the curative effect and prognosis of patients with PHC after TACE treatment.(J Intervent Radiol, 2019, 28: 591-594)
引文
[1]中华人民共和国国家卫生和计划生育委员会.原发性肝癌诊疗规范(2017年版)[J].传染病信息,2017,30:111-127.
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[3]European Association for the Study of the Liver.EASL Clinical Practice Guidelines:management of hepatocellular carcinoma[J].J Hepatol,2018,69:182-236.
[4]Torre LA,Bray F,Siegel RL,et al.Global cancer statistics,2012[J].CA Cancer J Clin,2015,65:87-108.
[5]何旭,占美晓,陆骊工.肝动脉化疗栓塞治疗肝细胞癌的应用现状与展望[J].中华介入放射学电子杂志,2018,6:124-126.
[6]王艳丽,房娜,曾磊,等.18F-FDG PET/CT对高18F-FDG摄取肝细胞肝癌经动脉插管化疗栓塞的疗效评价[J].中华核医学与分子影像杂志,2013,33:328-331.
[7]Park H,Park JY.Clinical significance of AFP and PIVKA-Ⅱresponses for monitoring treatment outcomes and predicting prognosis in patients with hepatocellular carcinoma[J].Biomed Res Int,2013,2013:310427.
[8]Hiraoka A,Ishimaru Y,Kawasaki H,et al.Tumor markers AFP,AFP-L3,and DCP in hepatocellular carcinoma refractory to transcatheter arterial chemoembolization[J].Oncology,2015,89:167-174.
[9]Vincenzi B,Di Maio M,Silletta M,et al.Prognostic relevance of objective response according to EASL criteria and m RECISTcriteria in hepatocellular carcinoma patients treated with locoregional therapies:a literature-based meta-analysis[J].PLoSOne,2015,10:e0133488.
[10]Xu JF,Liu XY.PIVKA-Ⅱis an independent prognostic factor for overall survival of HCC patients and maybe associated with epithelial-mesenchymal transition[J].J Hepatol,2015,63:1040-1041.
[11]Hemker HC,Veltkamp JJ,Hensen A,et al.Nature of prothrombin biosynthesis:preprothrombinaemia in vitamin K-deficiency[J].Nature,1963,200:589-590.
[12]Kokudo N,Hasegawa K,Akahane M,et al.Evidence-based Clinical Practice Guidelines for Hepatocellular Carcinoma:The Japan Society of Hepatology 2013 update(3rd JSH-HCC Guidelines)[J].Hepatol Res,2015,45:123-127.
[13]Kumar A,Acharya SK,Singh SP,et al.The Indian National Association for Study of the Liver(INASL)consensus on prevention,diagnosis and management of hepatocellular carcinoma in India:the puri recommendations[J].J Clin Exp Hepatol,2014,4(Suppl 3):S3-S26.
[14]European Association for the Study of the Liver,European Organisation for Research and Treatment of Cancer.EASL-EORTC clinical practice guidelines:management of hepatocellular carcinoma[J].J Hepatol,2012,56:908-943.
[15]杨霄霄,马红.肝细胞癌肿瘤标志物的研究进展[J].临床肝胆病杂志,2016,32:811-815.
[16]Chon YE,Choi GH,Lee MH,et al.Combined measurement of preoperativeα-fetoprotein and des-γ-carboxy prothrombin predicts recurrence after curative resection in patients with hepatitis-B-related hepatocellular carcinoma[J].Int J Cancer,2012,131:2332-2341.
[17]Toyoda H,Kumada T,Tada T,et al.Prognostic significance of a combination of pre-and post-treatment tumor markers for hepatocellular carcinoma curatively treated with hepatectomy[J].J Hepatol,2012,57:1251-1257.
[18]Lee HW,Song GW,Lee SG,et al.Patient selection by tumor markers in liver transplantation for advanced hepatocellular carcinoma[J].Liver Transpl,2018,24:1243-1251.
[19]Asaoka Y,Tateishi R,Nakagomi R,et al.Frequency of and predictive factors for vascular invasion after radiofrequency ablation for hepatocellular carcinoma[J].PLoS One,2014,9:111-119.
[20]任炜,杨薇.射频消融治疗复发性肝癌疗效及预后因素分析[J].介入放射学杂志,2015,24:923-927.
[21]Yoon SM,Ryoo BY,Lee SJ,et al.Efficacy and safety of transarterial chemoembolization plus external beam radiotherapy vs sorafenib in hepatocellular carcinoma with macroscopic vascular invasion:a randomized clinical trial[J].JAMA Oncol,2018,4:661-669.
[22]Park WH,Shim JH,Han SB,et al.Clinical utility of desgamma-carboxyprothrombin kinetics as a complement to radiologic response in patients with hepatocellular carcinoma undergoing transarterial chemoembolization[J].J Vasc Interv Radiol,2012,23:927-936.
[23]Wang SB,Cheng YN,Cui SX,et al.Des-gamma-carboxyprothrombin stimulates human vacular endothelial cell growth and migration[J].Clin Exp Metastasis,2009,26:469-477.
[24]Pote N,Cauchy F,Albuquerque M,et al.Performance of PIVKA-Ⅱfor early hepatocellular carcinoma diagnosis and prediction of microvascular invasion[J].J Hepatol,2015,62:848-854.
[25]鲁凤民.肝细胞癌的血清学诊断--挑战与希望同在[J].临床肝胆病杂志,2017,33:1262-1265.
[26]梁茂全,苏洪英.肝癌化疗栓塞前后甲胎蛋白变化模式的临床意义[J].介入放射学杂志,2012,21:333-338.
[27]高杨,纪建松,杨宏远,等.影像学检查在肝癌外科术后甲胎蛋白阴性患者随访中的价值[J].介入放射学杂志,2016,25:355-359.
[28]Park H,Kim SU,Park JY,et al.Clinical usefulness of double biomarkers AFP and PIVKA-Ⅱfor subdividing prognostic groups in locally advanced hepatocellular carcinoma[J].Liver Int,2014,34:313-321.
[29]Yamamoto K,Imamura H,Matsuyama Y,et al.AFP,AFP-L3,DCP,and GP73 as markers for monitoring treatment response and recurrence and as surrogate markers of clinicopathological variables of HCC[J].J Gastroenterol,2010,45:1272-1282.
[2]韩冰,祁兴顺,贾继东.亚太肝细胞癌管理临床实践指南推荐意见(2017年更新版)[J].临床肝胆病杂志,2017,33:1432-1434.
[3]European Association for the Study of the Liver.EASL Clinical Practice Guidelines:management of hepatocellular carcinoma[J].J Hepatol,2018,69:182-236.
[4]Torre LA,Bray F,Siegel RL,et al.Global cancer statistics,2012[J].CA Cancer J Clin,2015,65:87-108.
[5]何旭,占美晓,陆骊工.肝动脉化疗栓塞治疗肝细胞癌的应用现状与展望[J].中华介入放射学电子杂志,2018,6:124-126.
[6]王艳丽,房娜,曾磊,等.18F-FDG PET/CT对高18F-FDG摄取肝细胞肝癌经动脉插管化疗栓塞的疗效评价[J].中华核医学与分子影像杂志,2013,33:328-331.
[7]Park H,Park JY.Clinical significance of AFP and PIVKA-Ⅱresponses for monitoring treatment outcomes and predicting prognosis in patients with hepatocellular carcinoma[J].Biomed Res Int,2013,2013:310427.
[8]Hiraoka A,Ishimaru Y,Kawasaki H,et al.Tumor markers AFP,AFP-L3,and DCP in hepatocellular carcinoma refractory to transcatheter arterial chemoembolization[J].Oncology,2015,89:167-174.
[9]Vincenzi B,Di Maio M,Silletta M,et al.Prognostic relevance of objective response according to EASL criteria and m RECISTcriteria in hepatocellular carcinoma patients treated with locoregional therapies:a literature-based meta-analysis[J].PLoSOne,2015,10:e0133488.
[10]Xu JF,Liu XY.PIVKA-Ⅱis an independent prognostic factor for overall survival of HCC patients and maybe associated with epithelial-mesenchymal transition[J].J Hepatol,2015,63:1040-1041.
[11]Hemker HC,Veltkamp JJ,Hensen A,et al.Nature of prothrombin biosynthesis:preprothrombinaemia in vitamin K-deficiency[J].Nature,1963,200:589-590.
[12]Kokudo N,Hasegawa K,Akahane M,et al.Evidence-based Clinical Practice Guidelines for Hepatocellular Carcinoma:The Japan Society of Hepatology 2013 update(3rd JSH-HCC Guidelines)[J].Hepatol Res,2015,45:123-127.
[13]Kumar A,Acharya SK,Singh SP,et al.The Indian National Association for Study of the Liver(INASL)consensus on prevention,diagnosis and management of hepatocellular carcinoma in India:the puri recommendations[J].J Clin Exp Hepatol,2014,4(Suppl 3):S3-S26.
[14]European Association for the Study of the Liver,European Organisation for Research and Treatment of Cancer.EASL-EORTC clinical practice guidelines:management of hepatocellular carcinoma[J].J Hepatol,2012,56:908-943.
[15]杨霄霄,马红.肝细胞癌肿瘤标志物的研究进展[J].临床肝胆病杂志,2016,32:811-815.
[16]Chon YE,Choi GH,Lee MH,et al.Combined measurement of preoperativeα-fetoprotein and des-γ-carboxy prothrombin predicts recurrence after curative resection in patients with hepatitis-B-related hepatocellular carcinoma[J].Int J Cancer,2012,131:2332-2341.
[17]Toyoda H,Kumada T,Tada T,et al.Prognostic significance of a combination of pre-and post-treatment tumor markers for hepatocellular carcinoma curatively treated with hepatectomy[J].J Hepatol,2012,57:1251-1257.
[18]Lee HW,Song GW,Lee SG,et al.Patient selection by tumor markers in liver transplantation for advanced hepatocellular carcinoma[J].Liver Transpl,2018,24:1243-1251.
[19]Asaoka Y,Tateishi R,Nakagomi R,et al.Frequency of and predictive factors for vascular invasion after radiofrequency ablation for hepatocellular carcinoma[J].PLoS One,2014,9:111-119.
[20]任炜,杨薇.射频消融治疗复发性肝癌疗效及预后因素分析[J].介入放射学杂志,2015,24:923-927.
[21]Yoon SM,Ryoo BY,Lee SJ,et al.Efficacy and safety of transarterial chemoembolization plus external beam radiotherapy vs sorafenib in hepatocellular carcinoma with macroscopic vascular invasion:a randomized clinical trial[J].JAMA Oncol,2018,4:661-669.
[22]Park WH,Shim JH,Han SB,et al.Clinical utility of desgamma-carboxyprothrombin kinetics as a complement to radiologic response in patients with hepatocellular carcinoma undergoing transarterial chemoembolization[J].J Vasc Interv Radiol,2012,23:927-936.
[23]Wang SB,Cheng YN,Cui SX,et al.Des-gamma-carboxyprothrombin stimulates human vacular endothelial cell growth and migration[J].Clin Exp Metastasis,2009,26:469-477.
[24]Pote N,Cauchy F,Albuquerque M,et al.Performance of PIVKA-Ⅱfor early hepatocellular carcinoma diagnosis and prediction of microvascular invasion[J].J Hepatol,2015,62:848-854.
[25]鲁凤民.肝细胞癌的血清学诊断--挑战与希望同在[J].临床肝胆病杂志,2017,33:1262-1265.
[26]梁茂全,苏洪英.肝癌化疗栓塞前后甲胎蛋白变化模式的临床意义[J].介入放射学杂志,2012,21:333-338.
[27]高杨,纪建松,杨宏远,等.影像学检查在肝癌外科术后甲胎蛋白阴性患者随访中的价值[J].介入放射学杂志,2016,25:355-359.
[28]Park H,Kim SU,Park JY,et al.Clinical usefulness of double biomarkers AFP and PIVKA-Ⅱfor subdividing prognostic groups in locally advanced hepatocellular carcinoma[J].Liver Int,2014,34:313-321.
[29]Yamamoto K,Imamura H,Matsuyama Y,et al.AFP,AFP-L3,DCP,and GP73 as markers for monitoring treatment response and recurrence and as surrogate markers of clinicopathological variables of HCC[J].J Gastroenterol,2010,45:1272-1282.