Value of contrastation-enhanced ultrasound combined with abnormal prothrombin Ⅱ in predicting incomplete response after TACE in elderly patients with hepatocellular carcinoma
Objective To investigate the value of contrast-enhanced ultrasonography(CEUS)combined with abnormal prothrombin Ⅱ(PIVKA-Ⅱ)in predicting post-transarterial chemoembolization(TACE)incomplete response(CR)in elderly hepatocellular carcinoma(HCC)patients.Methods A total of 97 elderly HCC patients treated at Taiyuan Iron and Steel Group General Hospital from May 2019 to March 2022 were selected.The patients underwent TACE treatment,and serum PIVKA-Ⅱ levels were measured at 7 days after the operation.CEUS examination was performed at 3 months after the operation.According to the post-TACE therapeutic response,the patients were divided into CR group and non-CR group.The CEUS characteristics,serum PIVKA-Ⅱ levels,and clinical data of the two groups were compared.Multivariate stepwise logistic regression analysis was used to analyze the influencing factors of post-TACE incomplete response in elderly HCC patients.Receiver operating characteristic(ROC)curves were drawn to evaluate the predictive value of CEUS combined with PIVKA-Ⅱ.Results At 3 months after the operation,among the 97 patients,33 cases achieved CR,with an incidence rate of 34.02%,and 64 cases did not achieve CR,with an incidence rate of 65.98%.The non-CR group had higher arterial phase enhancement rate,delayed phase enhancement rate,and portal vein phase enhancement rate than the CR group(P<0.05).The proportion of tumors with diameter>5 cm in the non-CR group was higher than that in the CR group(P<0.05).Multivariate stepwise logistic regression analysis showed that arterial phase enhancement[O^R = 3.480(95%CI:1.530,7.916)],delayed phase enhancement[O^R = 4.293(95%CI:1.887,9.766)],portal vein phase enhancement[O^R = 2.726(95%CI:1.199,6.202)],elevated serum PIVKA-Ⅱ[O^R = 3.050(95%CI:1.341,6.937)],and tumor diameter>5 cm[O^R = 3.575(95%CI:1.572,8.133)]were influencing factors for post-TACE incomplete response in elderly HCC patients(P<0.05).ROC curve analysis showed that CEUS,serum PIVKA-Ⅱ alone,and combined prediction of post-TACE incomplete response in elderly HCC patients had sensitivities of 84.37%(95%CI:0.627,0.895),78.56%(95%CI:0.569,0.834),and 92.19%(0.702,0.958),respectively,and specificities of 60.61%(95%CI:0.523,0.731),78.79%(95%CI:0.583,0.852),and 84.85%(95%CI:0.627,0.920),respectively,with AUCs of 0.725(95%CI:0.625,0.811),0.760(95%CI:0.663,0.841),and 0.885(95%CI:0.804,0.942)(P<0.05),and the combined prediction had a higher AUC.Conclusion CEUS and serum PIVKA-Ⅱ have important value in predicting post-TACE incomplete response in elderly HCC patients,and the predictive value of the combination of the two is higher.
hepatocellular carcinomacontrast-enhanced ultrasonographyprothrombin Ⅱelderlytransarterial chemoembolizationcomplete responsepredictive value
维普
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