| Part ITHE CLINICAL VALUE OF GAMMA-GLUTAMYL TRANSFE RASE LEVEL IN THE DIAGNOSIS OF LIVER METASTASES FROM COLORECTAL CANCERObjectiveThis study was intended to investigate the clinical value of gamma-glutamyl transferase level in the diagnosis of liver metastases from colorectal cancer.MethodsA retrospective analysis was conducted on 485 colorectal cancer patients treated surgical therapy in the Shandong Provincal Qianfoshan hospital from January 2013 to January 2017,according to whether the liver metastases exists or not,485 patients were divided into two groups:liver metastases group(98 patients)and non metastases group(387 patients),carcinoembryonic antigen and 17 routine liver function indexes in two groups of patients were detected,compared and analyzed,selecting the statistically different indexes in comparison between two groups,drawing the receiver operating characteristic curve of single index detection and combined detection of the multi-indexes,calculating area under the curve,ROC analysis was performed to evaluate the clinical diagnostic value of single index detection and combined detection of the multi-indexes in colorectal liver metastases.Results(1)The clinical feature data of two groups showed that there was a significant difference between the two groups in primary lesion diameter,the degree of differentiation of primary lesion and the state of hepatitis B surface antigen(p<0.05).(2)In CEA and 17 normal liver function indexes,the CEA,GGT and ADA between the two groups were statistically significant(p<0.05).(3)The AUC of CEA,GGT and ADA was as following order:GGT(0.808)>ADA(0.718)>CEA(0.613).Clinical cutoff value of each index were:CEA:61.1ng/mL,SE:54.2%,SP:69.5%,LR+:1.8,LR-:0.7;GGT:80.8U/L,SE:67.8%,SP:91.5%,LR+:8.0,LR-:0.4;ADA:17.5U/L,SE:62.7%,SP:83.1%,LR_+:3.7,LR_-:0.5.(4)In all combined detection of two indexes groups,the highest AUC group was group GGT+ADA,AUC:0.811;the group GGT+ADA has the highest SE,SE:76.3%;the group CEA+GGT has the highest SP,SP:90%.In the combined detection of three indexes group,AUC,SE and SP was 0.815,78.1%and 89.8%.Conclusions(1)Serum GGT level has a certain clinical application value in diagnosing colorectal cancer liver metastases.(2)The diagnostic value of serum GGT for colorectal cancer liver metastases was higher than that of CEA and ADA.(3)By comprehensive analysis on area under the ROC curve,sensitivity and specificity,the best combined diagnostic combination was GGT+CEA+ADA.Part IITHE PROGNOSTIC SIGNIFICANCE OF GAMMA-GLUTAMYL TRANSFERASE LEVEL IN PATIENTS WITH COLORECTAL LIVER METASTASES AFTER MICROWAVE ABLATION TREATMENTObjectiveThis study was intended to investigate the prognostic significance of gamma-glutamyl transferase level in patients with colorectal liver metastases after microwave ablation treatment.MethodsA retrospective analysis was conducted on 80 patients with colorectal liver metastases treated MWA treatment in Department of Oncology in the Shandong Provincal Qianfoshan hospital from October 2012 to January 2014.The 45 patients(high GGT group,GGT≥60 U/L)and 35 patients(normal GGT group,GGT<60 U/L)were compared in survival rates and prognostic significance.Using the Kaplan-Meier method to calculate survival rates.The univariate analysis was carried out by Log-rank method,and the multivariate analysis was carried out by the Cox regression model.Results(1)The clinical feature data were compared between the two groups showed that the range of GGT value and the averange GGT value in high GGT group(45 patients)and normal GGT group(35 patients)were(61.2~146.7)U/L,(75.3±15.3)U/L and(2.63~59.6)U/L,(29.6 ±19.1)U/L respectively,the difference of GGT level between the two groups was statistically significant(p< 0.05).(2)The short-term effect of MWA in two groups was evaluated by imaging examination.The results of upper abdominal enhanced CT or MRI scan about one month were used as the basis for evaluating the efficacy of the two groups patients after MWA treatment,the complete ablation rate between the two groups was no statistically significant difference(p> 0.05).(3)The main postoperative complications of MWA were fever,pain,gastrointestinal reaction and transient aminotransferase elevation.The complications between the two groups was no statistically significant difference(p> 0.05).(4)The high GGT group patients after treatment of MWA,the cumulative recurrence rate of 12,18 and 24 months were 20/45(44.44%),31/45(68.89%)and 40/45(88.89%);the normal GGT group patients after treatment with MWA,the cumulative recurrence rate of 12,18 and 24 months were 10/35(28.57%),16/35(45.71%)and 24/35(68.57%),differences between the two groups after treatment,the cumulative recurrence rate of 12,18 and 24 months were statistically significant(p< 0.05).(5)The survival rates of patients in high GGT group and normal GGT group were analyzed by Kapla-Meier and Log-Rank.The difference between the two groups was statistically significant(p< 0.05).The median survival time was 15.3 months and 23.5 months respectively.The 12,18 and 24 months survival rate of high GGT group patients were 28/45(62.22%),21/45(46.67%)and 12/45(26.67%);the 12,18 and 24 months survival rate of normal GGT group patients were respectively 29/35(82.86%),25/35(71.43%)and 17/35(48.57%),the differences in 12,18 and 24 months survival rate of two group were statistically significant(p< 0.05).(6)The factors that may affect the prognosis after treatment of MWA in patients with colorectal liver metastases were analyzed by Kaplan-Meier single factor analysis and log-rank test,the results showed that the GGT level before MWA,liver metastases diameter,number of liver metastases,regional lymph node metastases,CEA level before MWA and Child-Pugh classification were prognostic factors.(p< 0.05).(7)Using the COX proportional hazard regression model to analyze the six factors which were meaningful in single factor analysis,the results revealed that the GGT level before MWA and liver metastases diameter were independent risk factors for patients with colorectal liver metastases(p<0.05),Child-Pugh classification was independent protective factor for patients with colorectal liver metastases(p<0.05).Conclusions(1)The level of serum GGT has a certain clinical significance in predicting the prognosis of colorectal patients with liver metastases after MWA treatment.(2)The GGT level before MWA and liver metastases diameter were independent risk factors for patients with colorectal liver metastases,Child-Pugh classification was independent protective factor for patients with colorectal liver metastases.(3)Liver metastases diameter,number of liver metastases and regional lymph node metastases were influence factors for patients with colorectal liver metastases,but not independent influence factors. |
