超声造影定量分析联合血清AFP、VEGFR-2、sTim-3对原发性肝癌TACE治疗疗效的预测价值

摘要 目的：探讨超声造影定量分析联合血清甲胎蛋白（AFP）、血管内皮生长因子受体-2（VEGFR-2）、可溶性T细胞免疫球蛋白粘蛋白分子3（sTim-3）对原发性肝癌肝动脉化疗栓塞（TACE）治疗疗效的预测价值。方法：选择2020年1月至2022年10月海军军医大学第二附属医院收治的原发性肝癌患者94例。行TACE治疗2个月，采用改良的实体瘤疗效评价标准评估患者疗效，根据不同疗效分为疗效不良组（n=32）和疗效良好组（n=62）。所有患者均行超声造影检查，比较两组超声造影定量分析参数、治疗前血清AFP、VEGFR-2、sTim-3水平，采用受试者工作特征（ROC）曲线分析超声造影定量分析参数联合血清AFP、VEGFR-2、sTim-3对原发性肝癌TACE治疗疗效的预测价值。结果：经TACE治疗，62例患者疗效良好、32例患者疗效不良，治疗有效率为65.96%。疗效良好组术前超声造影达峰时间、等增强开始时间显著长于疗效不良组（P<0.05）。疗效良好组术前血清AFP、VEGFR-2、sTim-3水平显著低于疗效不良组（P<0.05）。ROC曲线分析结果显示，超声造影定量分析联合血清AFP、VEGFR-2、sTim-3对原发性肝癌TACE治疗疗效预测的曲线下面积（AUC）为0.950，灵敏度为84.85%，特异度为82.12%，高于各指标单独检测。结论：超声造影定量分析参数、血清AFP、VEGFR-2、sTim-3水平可预测原发性肝癌患者TACE治疗的疗效，且联合诊断的预测效能更高。

Predictive Value of Contrast-enhanced Ultrasound Quantitative Analysis Combined with Serum AFP, VEGFR-2 and sTim-3 in the Efficacy of TACE Treatment in Primary Hepatocellular Carcinoma

ABSTRACT Objective: To investigate the predictive value of contrast-enhanced ultrasound quantitative analysis combined with serum alpha-fetoprotein (AFP), vascular endothelial growth factor receptor 2 (VEGFR2) and soluble T-cell immunoglobulin mucin molecule 3 (sTIM-3) in the efficacy of transcatheter arterial chemoembolization (TACE) treatment in primary hepatocellular carcinoma. Methods: 94 patients with primary hepatocellular carcinoma who were admitted to the Second Affiliated Hospital of the Naval Military Medical University from January 2020 to October 2022 were selected. The patients were treated with TACE for 2 months, and the modified efficacy evaluation criteria for solid tumor were used to evaluate the efficacy of the patients. According to the different efficacy, the patients were divided into poor efficacy group (n=32) and good efficacy group (n=62). All patients underwent contrast-enhanced ultrasound examination. Quantitative analysis parameters of contrast-enhanced ultrasound and serum AFP, VEGFR-2 and sTim-3 levels before treatment were compared in the two groups. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of contrast-enhanced ultrasound quantitative analysis parameters combined with serum AFP, VEGFR-2 and sTim-3 for the efficacy of TACE treatment with primary hepatocellular carcinoma. Results: After TACE treatment, 62 patients had good curative effect and 32 patients had poor curative effect, and the effective rate of treatment was 65.96%. The preoperative peak time and the equal enhancement start time of contrast-enhanced ultrasound in the good efficacy group were significantly longer than those in the poor efficacy group (P<0.05). The serum AFP, VEGFR-2 and sTim-3 levels in the good efficacy group were significantly lower than those in the poor efficacy group (P<0.05). ROC curve analysis results showed that the area under the curve (AUC) of contrast-enhanced ultrasound quantitative analysis combined with serum AFP, VEGFR-2 and sTim-3 for TACE treatment of primary hepatocellular carcinoma was 0.950, the sensitivity was 84.85%, and the specificity was 82.12%, which was higher than that of each index alone detection. Conclusion: The contrast-enhanced ultrasound quantitative analysis parameters, serum AFP, VEGFR-2 and sTim-3 levels can predict the efficacy of TACE treatment in patients with primary hepatocellular carcinoma, and the combined diagnosis has higher predictive efficacy.