超检测限AFP、CA19-9稀释后的检测结果对监测原发性肝癌栓塞治疗疗效的临床意义
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摘要
目的探讨超过检测上限的AFP和CA19-9进行稀释后的检测值对观察肝癌患者栓塞疗效的临床价值。方法将本院2013年1月至2017年12月明确诊断为原发性肝癌,进行栓塞治疗,且AFP或CA19-9治疗前后均超过检测上限的住院患者纳入本研究。将标本进行稀释,AFP稀释100倍,CA19-9稀释10倍,治疗前、后各检测一次。比较AFP和CA19-9治疗前后差异是否有统计学意义。结果治疗有效组AFP、CA19-9治疗前、后结果分别为53217.4±16395.7ng/mL、2949.7±862.5 U/mL和36152.8±17614.9 ng/mL、1508.7±485.9 U/mL,治疗无效组AFP、CA19-9治疗前、后结果分别为58143.5±20345.1 ng/mL、2649.8±793.4 U/mL和62672.8±23546.2 ng/mL、2815.6±827.4 U/mL,经过统计学分析,治疗有效组AFP、CA19-9治疗后水平明显降低,差异有统计学意义(P<0.01),治疗无效组AFP、CA19-9治疗后水平差异无统计学意义(P>0.05)。结果部分肝癌患者栓塞治疗前后AFP>1210 ng/mL或CA19-9>1000U/mL,超过检测上限,无法判断疗效,将标本进行稀释检测出具体值对观察肝癌患者栓塞疗效的判断具有重要的临床意义。
Objective To investigate the clinical value of the diluted values of AFP and CA19-9 exceeding the upper detection limit in the monitoring of the embolization effect in patients with hepatocellular carcinoma.Methods The hospital patients diagnosed as hepatocellular carcinoma and treated with embolization from January,2013 to December,2017,also AFP or CA19-9 exceeded the upper detection limit before and after the treatment were included in the study.The specimens were diluted,with AFP diluted 100 times and CA19-9 diluted 10 times.Patients were tested once before and after the embolization treatment.We then compared the statistical significance of AFP and CA19-9 before and after the treatment.Results The results of AFP and CA19-9 of the effective group before and after the treatment were 53217.4 ±16395.7 ng/mL,2949.7±862.5 U/mL and 36152.8 ±17614.9 ng/mL,1508.7±485.9 U/mL,respectively.The results of AFP and CA19-9 of ineffective group before and after the treatment were 5,8143.5 ±20345.1 ng/mL,2649.8 ±793.4 U/mL,and 62672.8±23546.2 ng/mL,2815.6 ±827.4 U/mL,respectively.The levels of AFP and CA19-9 in the treatment effective group were significantly decreased(P<0.01).There were no significant change of the levels of AFP and CA19-9 after the treatment in the treatment ineffective group(P>0.05).Conclusion The level of AFP or CA19-9 are exceeding the upper detection limit before and after embolization in some patients with hepatocellular carcinoma(AFP>1210 ng/mL or CA19-9>1000 U/mL),which makes it hard to judge the curative effect.Therefore,there is great clinical significance to dilute the specimen to obtain the specific AFP and CA19-9 values in order to observe the embolization effect of hepatocellular carcinoma patients.
Objective To investigate the clinical value of the diluted values of AFP and CA19-9 exceeding the upper detection limit in the monitoring of the embolization effect in patients with hepatocellular carcinoma.Methods The hospital patients diagnosed as hepatocellular carcinoma and treated with embolization from January,2013 to December,2017,also AFP or CA19-9 exceeded the upper detection limit before and after the treatment were included in the study.The specimens were diluted,with AFP diluted 100 times and CA19-9 diluted 10 times.Patients were tested once before and after the embolization treatment.We then compared the statistical significance of AFP and CA19-9 before and after the treatment.Results The results of AFP and CA19-9 of the effective group before and after the treatment were 53217.4 ±16395.7 ng/mL,2949.7±862.5 U/mL and 36152.8 ±17614.9 ng/mL,1508.7±485.9 U/mL,respectively.The results of AFP and CA19-9 of ineffective group before and after the treatment were 5,8143.5 ±20345.1 ng/mL,2649.8 ±793.4 U/mL,and 62672.8±23546.2 ng/mL,2815.6 ±827.4 U/mL,respectively.The levels of AFP and CA19-9 in the treatment effective group were significantly decreased(P<0.01).There were no significant change of the levels of AFP and CA19-9 after the treatment in the treatment ineffective group(P>0.05).Conclusion The level of AFP or CA19-9 are exceeding the upper detection limit before and after embolization in some patients with hepatocellular carcinoma(AFP>1210 ng/mL or CA19-9>1000 U/mL),which makes it hard to judge the curative effect.Therefore,there is great clinical significance to dilute the specimen to obtain the specific AFP and CA19-9 values in order to observe the embolization effect of hepatocellular carcinoma patients.
引文
[1]刘文东.原发性肝癌诊疗进展[J].中西医结合心血管病电子杂志,2018,6(31):162-163.
[2]宋来军.肿瘤标志物联合检测对原发性肝癌的诊断价值研究[J].中西医结合心血管病电子杂志,2018,6(27):88.
[3]RAOUL J L,FORNER A,BOLONDI L,et al.Updated use of TACE for hepatocellular carcinoma treatment:How and when to use it based on clinical evidence[J].Cancer Treat Rev,2019,72:28-36.
[4]ZHANG Y Q,JIANG L J,WEN J,et al.Comparison of a-fetoprotein criteria and modified response evaluation criteria in solid tumors for the prediction of overall survival of patients with hepatocellular carcinoma after transarterial chemoembolization[J].J Vasc IntervRadiol,2018,29(12):1654-1661.
[5]满沐苒,周旭林,刘清华.原发性肝癌肿瘤标志物研究进展[J].转化医学电子杂志,2018,5(11):61-66.
[6]YANG W,LUO Y,HU S,et al.Value of combined detection of serum carcino-embryonic antigen,carbohydrate antigen 19-9 and cyclooxygenase-2 in the diagnosis of colorectal cancer[J].Oncol Lett,2018,16(2):1551-1556.
[7]SAWAYAMA H,IWATSUKI M,KURODA D,et al.The association of the lymph node ratio and serum carbohydrate antigen 19-9 with early recurrence after curative gastrectomy for gastric cancer[J].Surg Today,2018,48(11):994-1003.
[8]SAKAMOTO T,SAITO H,UCHINAKA E I,et al.The combination of neutrophil-to-lymphocyte ratio and serum carbohydrate antigen19-9 level as a prognostic indicator in patients with recurrent pancreatic cancer[J].Anticancer Res,2018,38(9):5497-5503.
[9]YAMAMOTO Y,SUGIURA T, TODAKA A,et al.Surgical Indication for Advanced Intrahepatic Cholangiocarcinoma According to the Optimal Preoperative Carbohydrate Antigen 19-9 Cutoff Value[J].World J Surg,2018,42(10):3331-3340.
[10]刘永炜,吴向民.血清AFP、CA19-9和CEA水平在肝癌诊断和预后中的作用[J].检验医学,2017,32(5):406-409.
[11]LU LH,ZHANG YF,WEI W,et al.Preoperative carbohydrate antigen 19-9:its neglected role in alpha-fetoprotein-negative hepatocellular carcinoma patients[J].J Gastrointest Surg,2017,21(12):2025-2032.
[12]ZHANG J,HUANG T,ZHANG F,et al.Prognostic role of serum carbohydrate antigen 19-9 levels in patients with resectable hepatocellular carcinoma[J].Tumour Biol,2015,36(4):2257-2261.
[13]ZHOU L,RUI J A,WANG S B,et al.Carbohydrate antigen 19-9increases the predictive efficiency of alpha-fetoprotein for prognosis of resected hepatocellular carcinoma[J].Am Surg,2018,84(1):80-85.
[14]WANG X,WANG Q.Alpha-Fetoprotein and Hepatocellular Carcinoma Immunity[J].Can J Gastroenterol Hepatol,2018,2018:9049252.
[15]RAOUL J L,PARK J W,KANG Y K,et al.Using modified RECIST and alpha-fetoprotein levels to assess treatment benefit in hepatocellular carcinoma[J]. Liver Cancer,2014,3(3-4):439-450.
[16]SUN T,TANG Y,SUN D,et al.Osteopontin versus alpha-fetoprotein as a diagnostic marker for hepatocellular carcinoma:a meta-analysis[J].Onco Targets Ther,2018,11:8925-8935.
[17]MENG W,BAI B,BAI Z,et al.The immunosuppression role of alpha-fetoprotein in human hepatocellular carcinoma[J].Discov Med,2016,21(118):489-494.
[18]邱栾,张欣悦,李建雄.肝细胞癌治疗现状及展望[J].解放军医学院学报,2017,38(9):886-889.
[19]CERBAN R,ESTER C,IACOB S,et al.Predictive factors of tumor recurrence and survival in patients with hepatocellular carcinoma treated with transarterial chemoembolization[J].J Gastrointestin Liver Dis,2018,27(4):409-417.
[2]宋来军.肿瘤标志物联合检测对原发性肝癌的诊断价值研究[J].中西医结合心血管病电子杂志,2018,6(27):88.
[3]RAOUL J L,FORNER A,BOLONDI L,et al.Updated use of TACE for hepatocellular carcinoma treatment:How and when to use it based on clinical evidence[J].Cancer Treat Rev,2019,72:28-36.
[4]ZHANG Y Q,JIANG L J,WEN J,et al.Comparison of a-fetoprotein criteria and modified response evaluation criteria in solid tumors for the prediction of overall survival of patients with hepatocellular carcinoma after transarterial chemoembolization[J].J Vasc IntervRadiol,2018,29(12):1654-1661.
[5]满沐苒,周旭林,刘清华.原发性肝癌肿瘤标志物研究进展[J].转化医学电子杂志,2018,5(11):61-66.
[6]YANG W,LUO Y,HU S,et al.Value of combined detection of serum carcino-embryonic antigen,carbohydrate antigen 19-9 and cyclooxygenase-2 in the diagnosis of colorectal cancer[J].Oncol Lett,2018,16(2):1551-1556.
[7]SAWAYAMA H,IWATSUKI M,KURODA D,et al.The association of the lymph node ratio and serum carbohydrate antigen 19-9 with early recurrence after curative gastrectomy for gastric cancer[J].Surg Today,2018,48(11):994-1003.
[8]SAKAMOTO T,SAITO H,UCHINAKA E I,et al.The combination of neutrophil-to-lymphocyte ratio and serum carbohydrate antigen19-9 level as a prognostic indicator in patients with recurrent pancreatic cancer[J].Anticancer Res,2018,38(9):5497-5503.
[9]YAMAMOTO Y,SUGIURA T, TODAKA A,et al.Surgical Indication for Advanced Intrahepatic Cholangiocarcinoma According to the Optimal Preoperative Carbohydrate Antigen 19-9 Cutoff Value[J].World J Surg,2018,42(10):3331-3340.
[10]刘永炜,吴向民.血清AFP、CA19-9和CEA水平在肝癌诊断和预后中的作用[J].检验医学,2017,32(5):406-409.
[11]LU LH,ZHANG YF,WEI W,et al.Preoperative carbohydrate antigen 19-9:its neglected role in alpha-fetoprotein-negative hepatocellular carcinoma patients[J].J Gastrointest Surg,2017,21(12):2025-2032.
[12]ZHANG J,HUANG T,ZHANG F,et al.Prognostic role of serum carbohydrate antigen 19-9 levels in patients with resectable hepatocellular carcinoma[J].Tumour Biol,2015,36(4):2257-2261.
[13]ZHOU L,RUI J A,WANG S B,et al.Carbohydrate antigen 19-9increases the predictive efficiency of alpha-fetoprotein for prognosis of resected hepatocellular carcinoma[J].Am Surg,2018,84(1):80-85.
[14]WANG X,WANG Q.Alpha-Fetoprotein and Hepatocellular Carcinoma Immunity[J].Can J Gastroenterol Hepatol,2018,2018:9049252.
[15]RAOUL J L,PARK J W,KANG Y K,et al.Using modified RECIST and alpha-fetoprotein levels to assess treatment benefit in hepatocellular carcinoma[J]. Liver Cancer,2014,3(3-4):439-450.
[16]SUN T,TANG Y,SUN D,et al.Osteopontin versus alpha-fetoprotein as a diagnostic marker for hepatocellular carcinoma:a meta-analysis[J].Onco Targets Ther,2018,11:8925-8935.
[17]MENG W,BAI B,BAI Z,et al.The immunosuppression role of alpha-fetoprotein in human hepatocellular carcinoma[J].Discov Med,2016,21(118):489-494.
[18]邱栾,张欣悦,李建雄.肝细胞癌治疗现状及展望[J].解放军医学院学报,2017,38(9):886-889.
[19]CERBAN R,ESTER C,IACOB S,et al.Predictive factors of tumor recurrence and survival in patients with hepatocellular carcinoma treated with transarterial chemoembolization[J].J Gastrointestin Liver Dis,2018,27(4):409-417.