TACE联合射频消融后复发性肝癌患者血清E-cadherin、VEGF、DKK1变化及对生存预后的影响

洪晗; 金正康; 徐小永; 李高超; 徐敏晖

doi:10.16190/j.cnki.45-1211/r.2023.08.017

TACE联合射频消融后复发性肝癌患者血清E-cadherin、VEGF、DKK1变化及对生存预后的影响

Changes of serum E-cadherin, VEGF and DKK1 in patients with recurrent hepatocellular carcinoma after TACE combined with radiofrequency ablation and their effects on survival prognosis

摘要

摘要: 目的：分析复发性肝癌患者经导管肝动脉化疗栓塞术（TACE）联合射频消融后血清上皮钙黏素（E-cadherin）、血管内皮生长因子（VEGF）、分泌型蛋白Dickkopf-1（DKK1）变化及对生存预后的预测价值。方法：选取2016年1月至2022年3月苏州市立医院收治的190例肝癌术后复发患者，均给予TACE联合射频消融治疗，根据生存预后分为死亡组（30例）、生存组（160例）。比较两组基线资料、治疗前、TACE后、射频后血清E-cadherin、VEGF、DKK1变化；采用Cox分析生存预后的相关影响因素；采用受试者工作特征曲线（ROC）分析TACE后、射频后血清E-cadherin、VEGF、DKK1预测生存预后的价值；采用卡普兰—迈耶曲线（KM）生存曲线分析不同血清E-cadherin、VEGF、DKK1表达水平患者生存率。结果：死亡组BCLC分期高于生存组（P< 0.05）；死亡组TACE后、射频后血清E-cadherin低于生存组，VEGF、DKK1高于生存组（P< 0.05）；Cox分析显示，射频后血清Ecadherin是复发性肝癌患者生存预后的相关保护因素，BCLC分期、射频后血清VEGF和DKK1是复发性肝癌患者生存预后的相关危险因素（P< 0.05）；射频后血清E-cadherin、VEGF、DKK1 预测生存预后的ROC 下面积（AUC）大于TACE 后，且血清Ecadherin+VEGF+DKK1 的AUC 大于单独的血清E-cadherin、VEGF、DKK1（P< 0.05）；血清E-cadherin 高水平患者生存率高于低水平患者，VEGF、DKK1高水平患者生存率低于低水平患者（P< 0.05）。结论：血清E-cadherin、VEGF、DKK1变化与复发性肝癌TACE联合射频消融后生存预后有关，联合检测射频后三者表达水平为临床预测生存预后提供参考依据。

Abstract: Objective:To analyze the changes of serum E-cadherin, vascular endothelial growth factor (VEGF)and secreted protein Dickkopf-1 (DKK1) in patients with recurrent hepatocellular carcinoma after transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation and their predictive value for survival prognosis.Methods:A total of 190 patients with postoperative recurrence of hepatocellular carcinoma admitted to Suzhou Municipal Hospital from January 2016 to March 2022 were selected and were treated with TACE combined with radiofrequency ablation.They were divided into death group (30 cases) and survival group (160 cases)according to survival prognosis.The baseline data, changes in serum E-cadherin, VEGF and DKK1 before treatment, after TACE and radiofrequency were compared between the two groups.Cox was used to analyze the relative factors influencing survival prognosis, the receiver operating characteristic(ROC)curve was used to analyze the value of serum E-cadherin, VEGF and DKK1 after TACE and radiofrequency to predict survival prognosis, and the Kaplan-Meyer (KM) survival curve was used to analyze the survival rate of patients with different serum E-cadherin, VEGF and DKK1 expression levels.Results:BCLC stage was higher in the death group than in the survival group (P< 0.05); serum Ecadherin after TACE and radiofrequency was lower in the death group than in the survival group, and VEGF and DKK1 were higher than those in the survival group (P< 0.05); Cox analysis showed that serum E-cadherin after radiofrequency was a relevant protective factor for survival prognosis in patients with recurrent hepatocellular carcinoma, and BCLC stage, serum VEGF and DKK1 after radiofrequency were relevant risk factors for survival prognosis in patients with recurrent hepatocellular carcinoma(P< 0.05); the area under the ROC curve(AUC)of serum E-cadherin, VEGF, and DKK1 in predicting survival and prognosis after radiofrequency was more than that after TACE, and the AUC of serum E-cadherin+VEGF+DKK1 was more than that of serum E-cadherin, VEGF and DKK1 alone(P< 0.05); the survival rate of patients with high levels of serum E-cadherin was higher than that of patients with low levels, and the survival rate of patients with high levels of VEGF and DKK1 was lower than that of patients with low levels(P< 0.05).Conclusion:The changes in serum E-cadherin, VEGF and DKK1 are associated to the survival prognosis after TACE combined with radiofrequency ablation in recurrent hepatocellular carcinoma, and the expression levels of the three after combined radiofrequency detection can provide a reference basis for clinically predicting survival prognosis.

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