| Objective:To explore the value of serum alpha-fetoprotein(AFP), des-gamma-carboxy prothrombin(DCP) and Child-Pugh classification in the evaluation of therapeutic effect of hepatitis B virus(HBV) related hepatocellular carcinoma(HCC) patients treated with transcatheter arterial chemoembolization(TACE).To analyze the relevance between serum AFP/DCP expression levels and radiologic response.To research the application value of serum AFP/DCP in assistance of radiology to evaluate HCC treatment effect.Methods:We collected blood samples and clinical data in 66 cases ill with HBV-related HCC patients who treated by TACE at the first treatment in Treatment Center of Liver Disease of PLA,General Hospital of Beijing Military Area Command.ALL the blood samples detected serum DCP concentration by enzyme linked immunosorbent assay(ELISA) and serum AFP concentration by electrochemiluminescence immunization.Then patients whose AFP and DCP were both positive at first time were followed up and observed the change of these tumor markers before and after the treatment. The paper defining that the patients with TACE treatment get 0 point when AFP/DCP decreased ?20% than the baseline after one-month and get 1 point when AFP/DCP decreased <20% or increased than the baseline.The patients with Child-Pugh A get 0 point and the patients with Child-Pugh B get1 point before the treatment. To analyze the therapeutic effect of the patients with HCC when get score ? 1 points and ? 2 points. The levels of DCP and AFP 1-month, 3-monthand 6-month after the treatment were detected.We defined the serology responses as a decrease of at least 50% in AFP or DCP level from baseline.To analysize the Radiologic-serologic correlation and the relationship between serology responses and the time to disease progression(TTP).Results:(1) Among the 66 cases with HCC,there were 57(86.4%) patients whose DCP were positive. Correlation analysis showed that DCP and AFP did not display any obvious linear trend(r=-0.194,P=0.145).DCP expression was related with BCLC staging, tumor size,tumor number and portal vein thrombosis,but not with gender, age, viral load and Child-Pugh A/B.(2)Among the 57 patients, there were 40 cases with score?1 and 17 cases with score ?2.The patients whose score ?1 was significantly higher radiologic response rate(77.5% vs41.2%) than them whose score ?2 and there was statistically significant difference(c2=7.083, P=0.008). Survival analysis showed that they had significantly different TTP(10±0.79 months vs 6±0.66 months,c2=22.437, P<0.001).(3)57cases with HCC were followed up in 1-month,3-month and 6-month,AFP serologic response rates were 66.7%, 77.2%, 71.9% respectively.AFP serologic evaluation and radiologic evaluation had no significant difference(P>0.05).DCP serologic response rates were 52.6%, 63.2%, 54.4% respectively.DCP serologic evaluation and radiologic evaluation had no significant difference following 1-month and 3-month(P>0.05), but had statistical significance in the 6-month(c2=7.743, P=0.031).(4)Survival analysis for 57 cases showed that the patients who obtained serum AFP/DCP response got significantly longer time to disease progression. AFP serologic response/non-response of TTP was 10±1.21 months vs 7±1.11 months(c2= 5.673, P=0.017).DCP serologic response/non-response of TTP was 10±0.89 months vs 6±0.52months(c2=14.949,P<0.001).Conclusion:1.DCP is highly expressed in HCC patients at different levels.It have no relationship with AFP,age,gender and viral load.DCP closely related with tumor size, number, portal vein thrombosis and BCLC staging.2.The score of serum AFP/DCP changes and Child-Pugh A/B can evaluate the treatment effects of TACE.3.There are certain significance for therapeutic effect and prognosis evaluation of patients with HCC by combing the detection of serum AFP with imaging examination.4.The application of imaging examination combined with AFP detection to evaluate the treatment effect of HCC is only a preliminary exploration and still needs to be further explored. |
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