目的：探讨术前血清γ-谷氨酰转肽酶(gamma-glutamyl transferase，GGT)对中晚期青年肝癌患者经肝动脉化疗栓塞(TACE)治疗后的预后价值。方法回顾性收集2008年8月~2011年12月间解放军总医院介入放射科收治的116例接受TACE治疗的中晚期青年肝细胞癌(HCC)患者，按TACE术前血清GGT水平分为两组：正常GGT组38例(GGT<50 U/L)，高GGT组78例(GGT≥50 U/L)，比较其生存情况及预后因素。结果患者中位随诊时间为18.5(1~40)个月。正常GGT组和高GGT组TACE治疗前GGT水平分别为(35.8±13.5)U/L和(255.4±232.3)U/L，经统计学分析，两组差异有高度统计学意义(P<0.01)。两组患者的1、2、3年生存率分别为63.2%、47.2%、30.6%和48.7%、35.9%、20.5%。两组患者中位生存时间分别为31.3、20.3个月，经统计学分析，差异有高度统计学意义(P<0.01)。 Cox多元回归分析显示：术前GGT水平、血清甲胎蛋白(AFP)水平、肿瘤数目及有无门脉癌栓是中晚期青年HCC患者生存的独立危险因素。结论 TACE术前血清GGT水平可以作为判断TACE治疗中晚期青年HCC患者生存的独立预后因素。%Objective To evaluate the prognostic significance of serum GGT in young patients with primary hepatocel-lular carcinoma treated with TACE. Methods A retrospective analysis was conducted on 116 young patients with pri-mary hepatocellular carcinoma receiving TACE treatment in Department of Intreventional Radiology in the General Hospital of PLA from August 2008 to December 2011. Survival rates and prognostic significance were compared be-tween the 78 patients (high GGT group, GGT≥50 U/L) and 38 patients (normal GGT group, GGT<50 U/L). The sur-vival tates were calculated suing the Kaplan-Meier method. The Log-rank method was used for univariate analysis, and the Cox regression model was used for multivariate analysis. Results Follow-up was performed at a median of 18.5 months (range 1-40 months). The level of GGT was statistically different (P< 0.01) in the high GGT group and normal GGT group hefore TACE, which was respectively (255.4±232.3) U/L and (35.8±13.5)U/L. After patients treated with TACE, the 1, 2 and 3 year survival tares were 48.7%, 35.9% and 20.5% respectively in the high GGT group. The 1, 2 and 3 year survival tares were 63.2%, 47.2%and 30.6%respectively in the normal GGT group, it had statistical signifi-cance (P<0.01). Moreover, the Cox multivariant survival analysis revealed that portal vein tumor thrombus, tumor num-bers, serum AFP level, and the level of serum GGT before TACE were independent risk factors for hepatocellular carci-noma patients' survival in the middle-late youth. Conclusion The level of serum GGT before TACE is an important prog-nostic factor to predict the effect of TACE on patients with intermediate hepatitis C virus-related hepatocellular carcinoma.
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