ALBI、Caspase-4联合肿瘤ADC值对原发性肝癌患者TACE术后复发的预测价值

摘要/Abstract

摘要： 目的探讨白蛋白-胆红素(ALBI)、半胱氨酸天冬氨酸蛋白酶-4(Caspase-4)和表观扩散系数值(ADC)对原发性肝癌(PLC)患者行经肝动脉化疗栓塞术(TACE)术后复发的预测价值。方法选取内蒙古医科大学附属医院肝胆外科2022年1月至2024年12月收治的行TACE的PLC患者90例列入观察组,根据TACE术后6个月内是否复发,分为复发组(n=31)和非复发组(n=59);选择同期在本院健康体检人员90名列入对照组;检测和比较观察组和对照组以及观察组中复发组和非复发组的ALBI评分、Caspase-4水平和ADC值;应用Pearson分析评估观察组ALBI、Caspase-4和ADC与甲胎蛋白异质体3(AFP-L3)水平、Child-Pugh分级和终末期肝癌模型(MELD)评分相关性;绘制受试者工作特征(ROC)曲线,分析ALBI、Caspase-4和ADC联合检测对PLC患者TACE术后复发的预测效能。结果观察组的ALBI为(2.34±0.47)分,高于对照组的(1.05±0.26)分;Caspase-4和ADC为(34.59±4.62)ng/mL和(1.93±0.45)mm²/s,低于对照组的(57.86±6.37)ng/mL和(3.08±0.67)mm²/s,差异有统计学意义(t=10.265、12.364、8.792,均P＜0.05)。观察组中复发亚组的ALBI为(2.87±0.56)分,高于对照组的(1.93±0.32)分;Caspase-4和ADC为(23.65±3.09)ng/mL和(1.61±0.38)mm²/s,低于对照组的(40.27±5.16)ng/mL和(2.36±0.59)mm²/s,差异有统计学意义(t=9.014、11.276、8.317,均P＜0.05)。Pearson分析显示,观察组ALBI与AFP-L3、Child-Pugh分级和MELD评分呈正相关,Caspase-4和ADC与AFP-L3、Child-Pugh分级和MELD评分呈负相关(P＜0.05);ROC曲线显示,ALBI、Caspase-4和ADC水平单一和联合检测评估PLC患者TACE术后复发的AUC分别为0.752、0.783、0.826和 0.915,联合检测的灵敏度和特异度均高于任一单项检测结果(均P＜0.05)。结论 ALBI、Caspase-4和ADC联合检测对PLC患者TACE术后复发的预测价值较高。

关键词: 原发性肝癌, 肝动脉化疗栓塞, 复发, 血清学指标, 预测效能

Abstract: Objective To explore the predictive value of albumin-bilirubin (ALBI), cysteine aspartic acid protease-4 (Caspase-4), and apparent diffusion coefficient value (ADC) for the recurrence of primary liver cancer (PLC) in patients after transarterial chemoembolization (TACE) therapy. Methods A total of 90 PLC patients who underwent TACE therapy and were admitted to the Department of Hepatobiliary Surgery of the Affiliated Hospital of Inner Mongolia Medical University from January 2022 to December 2024 were selected as the observation group. According to whether recurrence occurred within 6 months after TACE, they were divided into a recurrence group (n=31 cases) and a non-recurrence group (n=59 cases). Ninety healthy individuals who underwent physical examinations in our hospital during the same period of time were selected and included in the control group. The ALBI score, Caspase-4 level and ADC value were detected and compared between the observation group and the control group, and between the recurrence group and the non-recurrence group in the observation group. Pearson analysis was used to analyze the correlations between ALBI, Caspase-4 and ADC in the observation group and the levels of alpha-fetoprotein heterogeneity 3 (AFP-L3), Child-Pugh classification and Model for advanced liver Cancer (MELD) score. The receiver operating characteristic curve (ROC) was drawn to analyze the predictive efficacy of the combined detection of ALBI, Caspase-4 and ADC for the recurrence of PLC in patients after TACE treatment. Results The ALBI of the observation group was (2.34±0.47) points, which was higher than that of the control group (1.05±0.26 points). The Caspase-4 and ADC were (34.59±4.62) ng/mL and (1.93±0.45) mm²/s, respectively, which were lower than those of (57.86±6.37) ng/mL and (3.08±0.67) mm²/s in the control group, and the differences were statistically significant (t=10.265, 12.364, 8.792) All P<0.05. The ALBI of the recurrence subgroup in the observation group was (2.87±0.56) points, which was higher than that of the control group (1.93±0.32 points). The Caspase-4 and ADC were (23.65±3.09) ng/mL and (1.61±0.38) mm²/s, respectively, which were lower than those of the control group [(40.27±5.16) ng/mL and (2.36±0.59) mm²/s], and the differences were statistically significant (t=9.014, 11.276, 8.317) All P<0.05. Pearson analysis showed that in the observation group, ALBI was positively correlated with AFP-L3, Child-Pugh classification and MELD score, while Caspase-4 and ADC were negatively correlated with AFP-L3, Child-Pugh and MELD score (P<0.05). The ROC curve showed that the AUCs of single and combined detection of ALBI, Caspase-4 and ADC levels for evaluating the recurrence of PLC patients after TACE were 0.752, 0.783, 0.826 and 0.915, respectively. The sensitivity and specificity of the combined detection were both higher than those of any single detection (all P<0.05). Conclusion The combined detection of ALBI, Caspase-4 and ADC has a relatively higher predictive value for the recurrence of PLC patients after TACE therapy.

Key words: Primary liver cancer, Transarterial chemoembolization, Recurrence, Serological indicators, Predictive value

杨瑜婧, 刘立业, 杨慧芳, 鄂楠, 王震侠. ALBI、Caspase-4联合肿瘤ADC值对原发性肝癌患者TACE术后复发的预测价值[J]. 肝脏, 2025, 30(12): 1637-1641.

YANG Yu-jing, LIU Li-ye, YANG Hui-fang, E Nan, WANG Zhen-xia. The efficacy of ALBI, Caspase-4 combined with tumor apparent diffusion coefficient value for predicting the recurrence of primary liver cancer in patients after transarterial chemoembolization therapy[J]. Chinese Hepatolgy, 2025, 30(12): 1637-1641.

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