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目的探讨原发性肝癌外科治疗前后血清甲胎蛋白(AFP)和可溶性细胞间黏附分子-1(sICAM-1)水平的变化对其生存预测的价值。方法回顾性分析在西京医院和解放军第451医院接受肝癌切除术或射频消融(RFA)治疗的86例肝癌患者的临床资料及随访结果,观察患者治疗前后外周血AFP和sICAM-1水平的变化,并根据其变化情况对患者进行分组,再对各组的生存情况进行分析。结果治疗前AFP<20μg/L或sICAM-1<1000 U/L的患者,其治疗后的肿瘤复发率及生存率高于治疗前两指标水平较高组(AFP:P=0.018,P<0.001;sICAM-1;P=0.027,P<0.001);较大肿瘤病灶、较晚TNM分期和较高的肿瘤复发率与治疗后两指标增高者有关(AFP:P=0.016,P=0.026及P=0.025;sICAM-1;P<0.001、P=0.024及P=0.032);治疗前两指标正常及治疗前增高但治疗后恢复正常者有较好的生存情况,尤其是在接受肝癌切除术患者中更为明显(AFP:P=0.006及P=0.001;sICAM-1;P=0.001及P=0.002);两指标联合分析结果表明,AFP和sICAM-1同时增高者,其无瘤生存率和总体生存率最差(P=0.007,P<0.001)。结论对于接受肝癌根治术的患者,检测术后早期血清中AFP和sICAM-1的水平变化,对于监测肿瘤复发和预测生存情况有较高的临床应用价值。
Objective To investigate the value of serum AFP and sICAM-1 levels in the prognosis of primary hepatocellular carcinoma before and after surgical treatment. Methods The clinical data and follow-up results of 86 HCC patients undergoing HCC or radiofrequency ablation (RFA) at Xijing Hospital and 451 Hospital of PLA were retrospectively analyzed. The changes of peripheral blood AFP and sICAM-1 levels were observed before and after treatment. Patients were grouped according to their changes and the survival of each group was analyzed. Results The patients with AFP <20μg / L or sICAM-1 <1000 U / L before treatment had higher tumor recurrence rate and survival after treatment than those before treatment (AFP: P = 0.018, P <0.001) ; sICAM-1; P = 0.027, P <0.001). The larger tumor lesions, the later TNM stage and the higher tumor recurrence rate were related to the two indicators after treatment (AFP: P = 0.016, P = 0.026 and P = 0.025; sICAM-1; P <0.001, P = 0.024 and P = 0.032). Before treatment, the two indexes were normal and pre-treatment increased but recovered well after treatment, especially in patients undergoing hepatectomy (AFP: P = 0.006 and P = 0.001; sICAM-1; P = 0.001 and P = 0.002). The combined analysis of the two indicators showed that the tumor-free survival rate of both AFP and sICAM- The overall survival rate was the worst (P = 0.007, P <0.001). Conclusions For the patients undergoing radical resection of liver cancer, the changes of the serum levels of AFP and sICAM-1 in the early postoperative period are of high clinical value in monitoring the recurrence of tumor and predicting the survival.