肝细胞癌发生肺转移的危险因素和血清学指标的评估价值

摘要/Abstract

摘要： 目的分析肝细胞癌(HCC)发生肺转移的相关危险因素和血清学指标的评估价值。方法选择无锡市锡山区中医院2020年1月至2023年12月收治的HCC患者128例,根据诊治2年内是否发生肺转移,分为肺转移组37例和无肺转移组81例。收集和比较研究对象的基线资料和临床指标,采用logistic多因素回归分析HCC发生肺转移的危险因素;受试者工作曲线分析各项指标预测HCC发生肺转移的价值。结果肺转移组的术前CHB病史、肿瘤直径＞5 cm、肿瘤数目＞2枚、存在PVTT和肝硬化、采取非手术治疗比例以及NLR、ALBI、AFP-L3和PIVKA-Ⅱ水平分别为72.97%、51.35%、56.76%、67.57%、59.46%、70.27%、0.29、-1.86、(95.49±11.27)μg/L、(548.16±65.34)mAU/mL,均高于无肺转移组的51.85%、29.63%、33.33%、34.57%、37.04%、53.09%、0.42、-3.28、(45.16±6.45)μg/L、(207.35±26.09)mAU/mL,差异有统计学意义(t/χ²/Z=3.762、4.084、3.917、4.526、4.073、3.659、7.268、9.436、11.264、13.538,均P<0.05)。logistics回归分析显示,术前存在CHB病史和PVTT、NLR、ALBI、AFP-L3和PIVKA-Ⅱ水平升高为HCC患者发生肺转移的独立影响因素(95%CI为0.905～1.126、0.751～0.863、0.816～1.274、0.875～1.427、1.034～1.568、0.843～1.369,OR=0.934、0.803、1.024、1.126、1.359、1.107,均P<0.05)。术前存在CHB病史和PVTT,NLR、ALBI、AFP-L3和PIVKA-Ⅱ水平的曲线下面积(AUC)分别为0.709、0.725、0.817、0.810、0.881、0.852,敏感度为70.27%、81.08%、86.49%、83.78%、94.59%、89.19%,特异度为64.86%、67.57%、78.38%、72.97%、83.78%、91.89%(均P<0.01)。结论 HCC患者术前存在CHB病史和PVTT、NLR、ALBI、AFP-L3和PIVKA-Ⅱ水平异常升高是发生肺转移的独立危险因素,可为早期预警、诊断治疗和预后评估提供参考依据。

关键词: 肝细胞癌, 肺转移, 危险因素, 评估指标

Abstract: Objective To evaluate the risk factors and serological indexes related to lung metastasis in patients with hepatocellular carcinoma (HCC), and to provide reference for early diagnosis and treatment of HCC lung metastasis and improvement of prognosis. Methods A total of 128 HCC patients admitted to Xishan District Hospital of Traditional Chinese Medicine of Wuxi City from January 2020 to December 2023 were involved and divided into lung metastasis group (n=37) and no lung metastasis group (n=81) according to whether lung metastasis occurred within 2 years of diagnosis and treatment. The baseline data and clinical indicators of the subjects were collected and compared, and the risk factors of lung metastasis in HCC were analyzed by logistic multivariate regression. The receiver operating curve (ROC) was plotted to analyze risk factors and the estimated value of the predictive model. Results The preoperative history of CHB, tumor diameter > 5 cm, number of tumors > 2, presence of PVTT and cirrhosis, proportion of non-operative treatment and NLR, ALBI, AFP-L3 and PIVKA-Ⅱ levels were 72.97%, 51.35%, 56.76%, 67.57%, 59.46% and 70.27, respectively %, 0.29, -1.86, 95.49±11.27 μg/L, 548.16±65.34 mAU/mL, They were higher than those in the group without lung metastasis (51.85%, 29.63%, 33.33%, 34.57%, 37.04, 53.09%, 0.42, -3.28, 45.16±6.45 μg/L, 207.35±26.09 mAU/mL), and the difference was statistically significant (t/χ²/Z=3.762, 4.084,3.917,4.526, 4.073, 3.659, 7.268, 9.436, 11.264, 13.538 were all P<0.05). Logistics regression analysis showed that CHB history and PVTT existed before surgery, increased levels of NLR, ALBI, AFP-L3 and PIVKA-Ⅱ were independent factors for lung metastasis in HCC patients (95%CI: 0.905 ~ 1.126, 0.751 ~ 0.863, 0.816 ~ 1.274, 0.875 ~ 1.427, 1.034 ~ 1.568, 0.843 ~ 1). 369, OR=0.934, 0.803, 1.024, 1.126, 1.359, 1.107, all P<0.05). ROC analysis showed that the area under the curve (AUC) of preoperative CHB history and PVTT, NLR, ALBI, AFP-L3 and PIVKA-Ⅱ levels were 0.709, 0.725, 0.817, 0.810, 0.881 and 0.852, respectively. The sensitivity was 70.27%, 81.08%, 86.49%, 83.78%, 94.59%, 89.19%, and the specificity was 64.86%, 67.57%, 78.38%, 72.97%, 83.78%, 91.89% (all P<0.01). Conclusion Preoperative history of CHB and abnormal elevation of PVTT, NLR, ALBI, AFP-L3 and PIVKA-Ⅱ levels in HCC patients are independent risk factors for lung metastasis, which can provide a reference for early warning, diagnosis and treatment and prognosis evaluation.

Key words: HCC, Pulmonary metastasis, Risk factors, Evaluation index

罗晓卫, 周利江, 徐冲. 肝细胞癌发生肺转移的危险因素和血清学指标的评估价值[J]. 肝脏, 2025, 30(2): 226-230.

LUO Xiao-wei, ZHOU Li-jiang, XU Chong. Risk factors for pulmonary metastasis in patients with hepatocellular carcinoma[J]. Chinese Hepatolgy, 2025, 30(2): 226-230.

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