Abstract:

Objective　To assess the predictive value of serum gamma-glutamyl transferase (GGT) level for the clinical efficacy and survival outcomes of patients with primary hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE) and sorafenib. Methods　One hundred and ten patients with HCC treated at Hanzhong Central Hospital from June 2020 to June 2022 were selected as the study objects. The patients were divided into a high-expression group (65 cases) and a low-expression group (45 cases) according to their serum GGT level before the treatment using a threshold of 50 U/L. The high-expression group had 34 males and 31 females, with 33 cases >60 years old and 32 cases ≤60 years old. The low-expression group had 29 males and 16 females, with 24 cases >60 years old and 21 cases ≤60 years old. The objective response rates (ORR) and local control rates (LCR) after three months' treatment were compared between the two groups. The clinical data were compared between the two groups. The patient survival was assessed using the Kaplan-Meier method to estimate their overall survival (OS) and progression-free survival (PFS). The Cox regression models were used to analyze the impact of GGT and clinical characteristics on their survival outcomes. χ² and t tests were used for the statistical analysis. Results　After 3 months' treatment, the ORR and LCR in the low expression group were higher than those in the high-expression group [51.11% (23/45) vs. 32.31% (21/65) and 80.00% (36/45) vs. 32.31% (55/65); χ²=11.690 and 7.948; both P<0.05]. The proportions of the patients with portal vein tumor thrombus, higher ECOG score, lower tumor differentiation, maximum tumor diameter > 5 cm, and higher AFP level in the high-expression group were higher than those in the low-expression group (all P<0.05). After the 2-year follow-up, the survival rates of the low-expression group and the high-expression group were 75.56% (34/45) and 53.84% (35/65), respectively; the median PFS's were 11.0 months and 5.0 months; the median OS's were 21.0 months and 13.0 months; there were statistical differences between the two groups (all P<0.05). The univariate and multivariate Cox regression analyses showed that serum GGT level, portal vein tumor thrombus, ECOG score, tumor differentiation, maximum tumor diameter, tumor morphology, and AFP level were the independent factors influencing PFS and OS in the patients (all P<0.05). Conclusion　The low GGT expression group demonstrates superior treatment response and survival outcomes compared to the high GGT expression group.

Key words: Primary hepatocellular carcinoma,  , Gamma-glutamyl transferase,  , Transarterial chemoembolization,  , Sorafenib,  , Clinical efficacy,  , Prognosis

摘要：

目的　评估血清γ-谷氨酰转移酶（gamma-glutamyl transferase，GGT）水平预测经动脉化疗栓塞（transarterial chemoembolization，TACE）联合索拉菲尼治疗原发性肝癌（hepatocellular carcinoma，HCC）患者的临床疗效和生存结果的价值。方法　选取2020年6月至2022年6月汉中市中心医院收治的110例HCC患者为研究对象。根据治疗前血清GGT水平，以50 U/L为界限，将患者分为高表达组65例和低表达组45例。高表达组男34例，女31例，年龄>60岁33例，≤60岁32例。低表达组男29例、女16例，年龄>60岁24例，≤60岁21例。比较两组治疗3个月后客观缓解率（objective response rate，ORR）和局部控制率（local control rate，LCR）。比较两组临床资料。采用Kaplan-Meier法评估患者总生存期（overall survival，OS）和无进展生存期（progression-free survival，PFS）。采用Cox回归模型分析GGT水平和临床特征对生存结果的影响。采用χ2检验和t检验进行统计分析。结果　治疗3个月后，低表达组ORR、LCR均高于高表达组［51.11%（23/45）比32.31%（21/65）、80.00%（36/45）比32.31%（55/65）；χ2=11.690、7.948，均P<0.05］。高表达组门静脉癌栓、较高的美国东部肿瘤合作组（Eastern Cooperative Oncology Group，ECOG）评分、较低肿瘤分化程度、肿瘤长径>5 cm及较高的甲胎蛋白（alpha-fetoprotein，AFP）水平患者占比均高于低表达组（均P<0.05）。随访2年后，低表达组和高表达组生存率分别为75.56%（34/45）、53.84%（35/65），中位PFS分别为11.0个月和5.0个月，中位OS分别为21.0个月和13.0个月，差异均有统计学意义（均P<0.05）。单因素、多因素Cox回归分析均表明血清GGT水平、门静脉癌栓、ECOG评分、肿瘤分化程度、肿瘤长径、肿瘤形态、AFP水平是HCC患者PFS和OS的独立影响因素（均P<0.05）。结论　低GGT表达组在治疗反应和生存结果上均优于高GGT表达组。

关键词: 原发性肝癌,  ,  , γ-谷氨酰转移酶,  ,  , 经动脉化疗栓塞,  ,  , 索拉菲尼,  ,  , 临床疗效,  ,  , 预后