您的位置:山东大学 -> 科技期刊社 -> 《山东大学学报(医学版)》

山东大学学报 (医学版) ›› 2018, Vol. 56 ›› Issue (10): 58-63.doi: 10.6040/j.issn.1671-7554.0.2018.1019

• • 上一篇    

人异常凝血酶原(PIVKA-II)在监测结直肠癌肝转移中的应用

朱宇,王宏洁,韩彬彬,冯莎娜,张春,李学祥,韩晓红,崔巍   

  1. 国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院检验科, 北京100021
  • 收稿日期:2018-09-03 发布日期:2022-09-27
  • 通讯作者: 崔巍. E-mail:wendycuiwei@sina.cn
  • 基金资助:
    中国医学科学院医学与健康科技创新工程(2017-I2M-3-005)

A study of serum PIVKA-II in patients with liver metastasis of colorectal cancer

ZHU Yu, WANG Hongjie, HAN Binbin, FENG Shana, ZHANG Chun, LI Xuexiang, HAN Xiaohong, CUI Wei   

  1. Department of Clinical Laboratory, National Cancer Center;
    National Clinical Research Center for Cancer;
    Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
  • Received:2018-09-03 Published:2022-09-27

摘要: 目的 探讨人异常凝血酶原即维生素K缺乏或拮抗剂II诱导的蛋白(PIVKA-II)在监测结直肠癌肝转移中的应用价值。 方法 采集治疗前结直肠癌患者120例(结直肠癌无器官转移组80例和结直肠癌肝转移组40例)、早期肝癌患者(早期肝癌组)80例和查体健康人群(健康组)80例血清样本,检测其PIVKA-II和癌胚抗原(CEA)浓度,确定PIVKA-II监测结直肠癌肝转移的临界值,分析PIVKA-II和CEA对监测结直肠癌肝转移的诊断效能。 结果 健康组、结直肠癌无器官转移组、结直肠癌肝转移组和早期肝癌组的血清PIVKA-II浓度依次呈增高趋势,分别为18(15~20.8)mAU/mL、20(17~24)mAU/mL、32(22.3~41.8)mAU/mL和345(31.8~3 787)mAU/mL,结直肠癌肝转移组显著高于健康组(P<0.001)和结直肠癌无器官转移组(P<0.001),低于早期肝癌组(P<0.001)。血清PIVKA-II检测结直肠癌肝转移的曲线下面积(AUC)为0.818(95%CI:0.736~0.901),与CEA的AUC差异无统计学意义[0.799(95%CI:0.710~0.888),Z=0.332,P=0.74]。PIVKA-II检测结直肠癌肝转移的最佳临界值为28.5 mAU/mL,此时灵敏度为60%,特异度为90%。联合PIVKA-II和CEA,结直肠癌患者肝转移的检测灵敏度提高到85%。 结论 血清PIVKA-II可用于结直肠癌肝转移的监测。

关键词: 人异常凝血酶原, 癌胚抗原, 结直肠癌, 肝转移, 诊断

Abstract: Objective To evaluate the diagnostic value of serum prothrombin induced by vitamin K absence or antagonist-II(PIVKA-II)in patients with liver metastasis of colorectal cancer(CRC). Methods A total of 120 CRC patients(including 80 without organ metastasis and 40 with liver metastasis), 80 patients with early-stage hepatocellular carcinoma(HCC)and 80 healthy controls were involved in the study. The levels of serum PIVKA-II and carcinoembryonic antigen(CEA)were determined to evaluate the optimal cut-off values. The diagnostic sensitivity and specificity of PIVKA-II and CEA for the liver metastasis of CRC were analyzed. Results The median concentrations of serum PIVKA-II in healthy controls, CRC patients without organ metastasis, CRC patients with liver metastasis and early-stage HCC patients were 18(15-20.8)mAU/mL, 20(17-24)mAU/mL, 32(22.3-41.8)mAU/mL and 345(31.8-3 787)mAU/mL, respectively. The median PIVKA-II level was significantly greater in CRC patients with liver metastasis 山 东 大 学 学 报 (医 学 版)56卷10期 -朱宇,等.人异常凝血酶原(PIVKA-II)在监测结直肠癌肝转移中的应用 \=-than that in healthy controls (P<0.001)and CRC patients without organ metastasis(P<0.001), but significantly lower than that in early-stage HCC patients(P<0.001). There was no significant difference between PIVKA-II and CEA in the area under the receiver operating characteristic curve(AUC)[0.818(95%CI: 0.736-0.901)vs 0.799(95%CI: 0.710-0.888), Z=0.332, P=0.74]. The optimal cut-off value of PIVKA-II for the detection of CRC liver metastasis was 28.5 mAU/mL, with sensitivity of 60% and specificity of 90%. A combination of PIVKA-II and CEA increased the sensitivity(85%)in detecting CRC liver metastasis. Conclusion PIVKA-II could serve as a marker for CRC liver metastasis screening.

Key words: Prothrombin induced by vitamin k absence or antagonist-II, Carcinoembryonic antigen, Colorectal cancer, Liver metastasis, Diagnosis

中图分类号: 

  • R735.3
[1] Chen WQ, Zheng RS, Baade PD, et al. Cancer Statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2): 115-132.
[2] 中华医学会外科学分会胃肠外科学组, 中华医学会外科学分会结直肠外科学组,中国抗癌协会大肠癌专业委员会, 等. 中国结直肠癌肝转移诊断和综合治疗指南(2018版)[J]. 中华消化外科杂志, 2018, 17(6): 527-539. Section of Gastrointestinal Surgery, Branch of Surgery, Chinese Medical Association, Section of Colorectal Surgery, Branch of Surgery, Chinese Medical Association, Chinese Society of Colon Cancer, China Anti-cancer Association, et al. Guideline for the diagnosis and comprehensive treatment of colorectal cancer liver metastasis(2018 edition)[J]. Chinese Journal of Digestive Surgery, 2018, 17(6): 527-539.
[3] 刘鸿章, 段文都, 周超熙, 等. 血清癌胚抗原、甲胎蛋白和低聚糖肿瘤相关糖类抗原的检测应用于结直肠癌肝转移的诊断[J]. 中日友好医院学报, 2009, 23(5): 295-297.
[4] Liebman HA, Furie BC, Tong MJ, et al. Des-gamma-carboxy(abnormal)prothrombin as a serum marker of primary hepatocellular carcinoma[J]. N Engl J Med, 1984, 310(22): 1427-1431.
[5] 朱宇, 王海, 王宏洁, 等. 血清PIVKA-II在肝癌诊断中的应用[J]. 临床和实验医学杂志, 2014, 13(7): 513-516. ZHU Yu, WANG Hai, WANG Hongjie, et al. Study on the significance of serum PIVKA-II in diagnosis of hepatoceilular carcinoma[J]. Journal of Clinical and Experimental Medicine, 2014, 13(7): 513-516.
[6] Lok AS, Sterling RK, Everhart JE, et al. Des-gamma-carboxy prothrombin and alpha-fetoprotein as biomarkers for the early detection of hepatocellular carcinoma[J]. Gastroenterology, 2010, 138(2): 493-502.
[7] 中国抗癌协会肝癌专业委员会. 原发性肝癌的临床诊断与分期标准[J]. 中华肝脏病杂志, 2001, 6: 324.
[8] Siriwardena AK, Mason JM, Mullamitha S, et al. Management of colorectal cancer presenting with synchronous liver metastases[J]. Nat Rev Clin Oncol, 2014, 11(8): 446-459.
[9] Kanas GP, Taylor A, Primrose JN, et al. Survival after liver resection in metastatic colorectal cancer: review and meta-analysis of prognostic factors[J]. Clin Epidemiol, 2012, 4(1): 283-301.
[10] Qin X, Tang G, Gao R, et al. A multicenter study on PIVKA reference interval of healthy population and establishment of PIVKA cutoff value for hepatocellular carcinoma diagnosis in China[J]. Int J Lab Hematol, 2017, 39(4): 392-401.
[11] Venook AP, Niedzwiecki D, Innocenti F, et al. Impact of primary(1°)tumor location on overall survival(OS)and progression-free survival(PFS)in patients(pts)with metastatic colorectal cancer(mCRC): analysis of CALGB/SWOG 80405(Alliance)[J]. J Clin Oncol, 2016, 34(Suppl): 3504.
[12] Schrag D, Weng S, Brooks G, et al. The relationship between primary tumor sidedness and prognosis in colorectal cancer[J]. J Clin Oncol, 2016, 34(Suppl): 3505.
[13] Marques MC, Ribeiro HSC, Costa WL, et al. Is primary sidedness a prognostic factor in patients with resected colon cancer liver metastases(CLM)[J]. J Surg Oncol, 2018, 117(5): 858-863.
[14] Park IJ, Choi GS, Lim KH, et al. Serum carcinoembryonic antigen monitoring after curative resection for colorectal cancer: clinical significance of the preoperative level[J]. Ann Surg Oncol, 2009, 16(11): 3087-3093.
[15] Pakdel A, Malekzadeh M, Naghibalhossaini F. The association between preoperative serum CEA concentrations and synchronous liver metastasis in colorectal cancer patients[J]. Cancer Biomarkers, 2016, 16(2): 245-252.
[16] Gaitanidis A, Alevizakos M, Tsaroucha A. Predictive nomograms for synchronous distant metastasis in rectal cancer[J]. J Gastrointest Surg, 2018, 22(7): 1268-1276.
[17] 邓玉雪, 官玲玲. 比较几种血清肿瘤标志物在结直肠癌及其肝转移的诊断价值[J]. 中国实用医药, 2017, 12(13): 79-80.
[18] Yang WL, Luo YS, Hu SC, et al. Value of combined detection of serum carcino-embryonic antigen, carbohydrate antigen 19-9 and cyclooxygenase-2 in the diagnosis of colorectal cancer[J]. Oncol Lett, 2018, 16(2): 1551-1556.
[19] 石援援, 薄晓通, 董翠梅, 等. 结直肠癌患者血清CEA、CA199的表达变化与肝转移的多因素相关性分析[J]. 肿瘤药学, 2018, 8(3): 387-391. SHI Yuanyuan, BO Xiaotong, DONG Cuimei, et al. The expression of serum CEA and CA199 in colorectal Cancer patients and analysis on its relationship with liver metastasis[J]. Anti-Tumor Pharmacy, 2018, 8(3): 387-391.
[20] Xing H, Yan CL, Cheng LM, et al. Clinical application of protein induced by vitamin K antagonist-II as a biomarker in hepatocellular carcinoma[J]. Tumor Biol, 2016, 37(12): 15447-15456.
[21] Cui SX, Yu XF, Qu XJ, et al. Roles and signaling pathways of des-γ-carboxyprothrombin in the progression of hepatocellular carcinoma[J]. Cancer invest, 2016, 34(9): 459-464.
[22] Inagaki Y, Tang W, Makuuchi M, et al. Clinical and molecular insights into the hepatocellular carcinoma tumour marker des-gamma-carboxyprothrombin[J]. Liver Int, 2011, 31(1): 22-35.
[23] Lee JH, Lee SW. The roles of carcinoembryonic antigen in liver metastasis and therapeutic approaches[J]. Gastroenterol Res Pract, 2017, 2017: 7521987. doi:10.1155/2017/7521987.
[24] Sharma B, Srinivasan R, Chawla YK, et al. Clinical utility of prothrombin induced by vitamin K absence in the detection of hepatocellular carcinoma in Indian population[J]. Hepatol Int, 2010, 4(3): 569-576.
[25] Ertle JM, Heider D, Wichert M, et al. A combination of alpha-fetoprotein and des-gamma-carboxy prothrombin is superior in detection of hepatocellular carcinoma[J]. Digestion, 2013, 87(2): 121-131.
[1] 李波波 李道堂 刘曙光 王兴武. 食管癌患者血清中DKK-1的表达[J]. 山东大学学报(医学版), 2209, 47(6): 58-61.
[2] 徐平 于国放 李霞. 不同类型甲状腺上动脉PSV对Graves病与桥本氏甲状腺炎鉴别诊断的价值[J]. 山东大学学报(医学版), 2209, 47(6): 62-64.
[3] 王欣,邢春燕,杨艳平. 血清磷酸丙酮酸水合酶检测对诊断侵袭性白念珠菌感染的临床价值[J]. 山东大学学报(医学版), 2209, 47(6): 92-94.
[4] 查菁,郭婧,左秀丽. 少见类型肠梗阻病因病例报告1例并文献复习[J]. 山东大学学报 (医学版), 2022, 60(6): 130-132.
[5] 宋敏,周玉侠,高璐,刘娜,王菊,古晋,张艳萍. 1例6 q三体嵌合胎儿的产前诊断[J]. 山东大学学报 (医学版), 2022, 60(5): 109-113.
[6] 左立平,蒋丰洋,周斌彬,范金蕾,梁永锋,邓展昊,于德新. 术前MRI在预测169例肝细胞肝癌微血管侵犯及早期复发的价值[J]. 山东大学学报 (医学版), 2022, 60(3): 89-95.
[7] 王静,刘粉,曾荣,黄思源,许长娟,梁子婷,董亮. 以胸膜病变为特征的IgG4相关性肺疾病1例[J]. 山东大学学报 (医学版), 2022, 60(3): 114-116.
[8] 薛美娟,石艳,邵琳琳,王琳,张昀,张阿敏. 遗传性血栓性血小板减少性紫癜1例并文献复习[J]. 山东大学学报 (医学版), 2022, 60(3): 121-124.
[9] 张雪,白改改,陶国伟,吴海芳,罗霞,刘培淑. 脐尿管未闭导致膀胱脱垂同时合并脐膨出的罕见病例1例[J]. 山东大学学报 (医学版), 2022, 60(2): 115-117.
[10] 宋钰峰,宁豪,姚志刚,吴海虎,刘非凡,吕家驹. 肾上腺海绵状血管瘤临床及影像特征[J]. 山东大学学报 (医学版), 2022, 60(2): 37-42.
[11] 潘鹏飞,徐立升,纪坤乾,王得翔,李玉. 以呼吸衰竭起病的线粒体肌病1例及文献回顾[J]. 山东大学学报 (医学版), 2022, 60(2): 54-59.
[12] 陈峰,高沛,朱可嘉,丁森泰. 膀胱淋巴上皮瘤样癌1例[J]. 山东大学学报 (医学版), 2022, 60(1): 118-120.
[13] 王传新. 肿瘤液体活检[J]. 山东大学学报 (医学版), 2021, 59(9): 64-71.
[14] 许长娟,梁子婷,曾荣,黄思源,王静,董亮. 结节性硬化症合并肺淋巴管肌瘤病1例[J]. 山东大学学报 (医学版), 2021, 59(8): 119-121.
[15] 陈刚,张焰平,叶乐平,付冲,周春燕,张世栋. 造影增强超声内镜联合超声内镜引导下细针抽吸术对胰腺占位的诊断价值[J]. 山东大学学报 (医学版), 2021, 59(7): 68-73.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!