Analysis Of Prognostic Factors Of Hepatocellular Carcinoma With Portal Vein Tumor Thrombus And Diagnostic Value Of Serum Oligosaccharide Chain Test

Objective:This study aims to investigate the risk factors of poor prognosis in patients with HCC combined with PVTT and seek serum markers for early diagnosis of HCC.The study provides the basis for early diagnosis and intervention of patients with HCC in order to improve the animation prognosis of these patients.Method:(1)Cases of 195 patients with hepatocellular carcinoma combined with PVTT admitted to the First Affiliated Hospital of Nanchang University from January 2019 to December 2021 were collected as the experimental group,and 63 patients with hepatocellular carcinoma without thrombus during the same period were collected as the control group.Data collection and follow-up visit of the two groups were conducted until December 2022.The patients were divided into the death group and the survival group.Kaplan-Meier method was used to analyze and plot the survival curve.The Log-rank method was used to analyze the risk factors associated with poor prognosis in the two groups of patients with different outcomes.And then Cox regression multivariate analysis was performed on the factors that had an impact on the prognosis.(2)With the consent of the patients,78 HCC serum samples,56non-HCC serum samples,and 20 health people in the healthy control group were collected.G-test was performed by oligosaccharide chain detection kit to compare the samples.La Roche Cabas 601 automatic electroluminescence apparatus was used to detect and compared the serum AFP of patients.ROC curve was used to analyze the diagnostic efficacy.Chi-square test was used to compare the consistency of G-test positive rate among different groups.Results:(1)Among 258 patients with HCC,195 of them were combined with PVTT.The overall mortality rate reached 77.5%.The mortality rate in the group combined with PVTT was 83.07%,which was significantly higher than HCC patients without PVTT(48.53%)(P<0.05);The 1-year and 3-year survival rates of patients with HCC were26.7%and 16.3%,respectively,and showed statistically significant differences when compared to the patients without HCC(P<0.01).(2)Among patients with HCC,log-rank univariate analysis showed that age,PS grade,ALB,TBIL,and lymphocytes had a statistically significant impact on the prognosis(P<0.05);Cox multivariate analysis showed that PS grade>2,lymphocytes<1.7×10~9/L and TBIL>26 mmol/L are independent risk factors;Meanwhile,among the patients without PVTT,the results of univariate analysis showed that AFP,ALT,GGT,and ALB had an impact on the prognosis.Further Cox multivariate analysis showed that AFP and ALB were independent risk factors affecting the prognosis of patients without PVTT.(3)The positive rate of G-test in patients with HCC was 88.46%,which was significantly higher than the positive rate of AFP(64.1%)(P<0.05);The positive rate of G-test(94.4%)in patients with liver cancer combined with PVTT was significantly higher than that of AFP(77.8%);The positive rate of G-test in patients with PVTT(86.7%)was significantly higher than that of AFP(60.0%)(P<0.05).(4)In patients with HCC,the sensitivity and specificity of G-test for diagnosing liver cancer patients were 88.5%and 80.3%,respectively.The area under curve(AUC)was 0.836;In the AFP test,the sensitivity was 64.1%,the specificity was 55.5%,and the AUC was 0.598;The sensitivity and specificity of G-test in the screening test for HCC were higher than those of AFP(P<0.05).(5)In the combined diagnosis of G-test and AFP,the sensitivity of positive G-test or AFP was the highest,reaching 91.0%,and the AUC was 0.737.The specificity of both simultaneous positive reactions was the highest,86.9%,and the AUC was 0.696.Conclusions:The mortality rate of HCC patients with PVTT is extremely high.Once high PS scores,low lymphocytes,and elevated bilirubin occur,the risk of poor prognosis increases.G-test has high sensitivity and specificity in the early diagnosis of HCC,or can be used as an effective serum marker to predict the early occurrence of HCC.The combined diagnosis of G-test and AFP can further improve the early diagnostic efficacy of HCC patients,with important clinical application value and significance.