增强CT联合SPARCL1、VEGF、TK⁃1对原发性肝癌的诊断及预后预测价值

doi:10.3969/j.issn.1006-5725.2026.12.011

Abstract

Abstract:

Objective To explore a multi-factor model that integrates enhanced CT parameters with the assessment of tissue rich in cysteinyl acidic secretory protein-like 1 （SPARCL1）， serum vascular endothelial growth factor （VEGF）， and thymidine kinase-1 （TK-1） for evaluating the clinical value and prognosis of primary liver cancer. Methods A total of 213 patients with primary liver cancer admitted to our hospital from January 2021 to August 2024 were selected as the study group. Meanwhile， 213 patients who underwent surgery or were hospitalized for benign liver diseases， including liver cirrhosis， liver hemangioma， and liver cysts， during the same period were selected as the control group. The enhanced CT parameters （arterial phase enhancement difference， venous phase enhancement difference）， SPARCL1 levels measured by fluorescence quantitative polymerase chain reaction， VEGF levels， and TK-1 levels measured by enzyme-linked immunosorbent assay were compared between the two groups. The diagnostic efficacy of each index alone and in combination for liver cancer was evaluated. All patients in the study group underwent transarterial chemoembolization （TACE） treatment. Post-operative follow-up was carried out for 1 year， and 4 cases had missing data. The patients were classified into groups according to their prognosis， with 156 cases in the good prognosis group and 53 cases in the poor prognosis group. A logistic regression model was used to analyze the prognostic factors， and the receiver operating characteristic （ROC） curve was plotted to evaluate the predictive value of each index for poor prognosis. Results The differences in venous phase enhancement between the study group and the poor-prognosis group， along with the SPARCL1 mRNA level， were lower than those in the control group and the good-prognosis group （P < 0.05）. Meanwhile， the difference in arterial phase enhancement， as well as the levels of VEGF and TK-1， were higher than those in the control group and the good-prognosis group （P < 0.05）. The AUC value of enhanced CT combined with the detection of SPARCL1， VEGF， and TK-1 for diagnosing primary liver cancer was higher than that of each indicator alone （P < 0.05）， with a sensitivity of 76.06% and a specificity of 81.22%. Logistic regression analysis confirmed that a low degree of differentiation （OR = 3.284， 95%CI： 1.886 - 5.718）， tumor stage Ⅲ-Ⅳ （OR = 2.793， 95%CI： 1.486 - 5.249）， lymph node metastasis （OR = 2.702， 95%CI： 1.224 - 5.965）， a large difference in arterial phase enhancement （OR = 2.702， 95%CI： 1.182 - 6.179）， a high VEGF level （OR = 2.423， 95%CI： 1.279 - 4.590）， and a high TK-1 level （OR = 2.344， 95%CI： 1.264 - 4.347） were all risk factors for the poor prognosis of primary liver cancer patients （all P < 0.05）. A large difference in venous phase enhancement （OR = 0.379， 95%CI： 0.189 - 0.762）， and a high SPARCL1 level （OR = 0.360， 95%CI： 0.151 - 0.858） were all protective factors for the poor prognosis of primary liver cancer patients （all P < 0.05）. Based on this， a risk factor model was constructed as follows： logit（P） = 0.867 + 1.189 × Degree of Differentiation + 1.027 × Tumor Stage + 0.994 × Lymph Node Metastasis + 0.994 × Difference in Arterial Enhancement - 0.969 × Difference in Venous Enhancement - 1.021 × SPARCL1 + 0.885 × VEGF + 0.852 × TK-1. The combined prediction probability for each patient was calculated according to this model. The ROC curve was plotted with this probability serving as the test variable. The results indicated that the AUC value of this combined prediction model was 0.905， with a sensitivity of 81.13% and a specificity of 82.69%. The predictive value of this model was relatively high. Conclusions The enhanced CT parameters， along with the serum levels of SPARCL1， VEGF， and TK-1， exhibit significant differences among patients with primary liver cancer and those with benign liver diseases， as well as among patients with different prognoses after TACE surgery. The combined detection of multiple indicators holds good diagnostic value for primary liver cancer. A low degree of differentiation， tumor stage Ⅱ-Ⅳ， lymph node metastasis， a large difference in arterial-phase enhancement， a high VEGF level， and a high TK-1 level are risk factors for the poor prognosis of primary liver cancer. In contrast， a large difference in venous-phase enhancement and a high SPARCL1 level are protective factors. The combined prediction model based on these indicators demonstrates good predictive efficacy for the short-term prognosis of patients and can offer a reference for clinical prognosis assessment.

Key words: enhanced computed tomography, secreted protein acidic and rich in cysteine-like 1, vascular endothelial growth factor, thymidine kinase-1, primary liver cancer, prognosis

CLC Number:

R735.7

Huixin ZHENG,Yanjun CHEN,Wenying HU,Yuxing HOU,Zhongjiang HUANG. Diagnostic and prognostic value of enhanced CT combined with SPARCL1， VEGF， and TK-1 in primary liver cancer[J]. The Journal of Practical Medicine, 2026, 42(12): 2170-2178.

Figures/Tables 10

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References 28

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因素	观察组（n = 213）	对照组（n = 213）	χ² /t值	P值
年龄（x ± s）/岁	60.43 ± 5.27	59.83 ± 4.86	1.221	0.223
性别/［例（%）］			0.468	0.494
男	124（58.22）	117（54.93）
女	89（41.78）	96（45.07）
BMI（x ± s）/（kg/m²）	23.80 ± 1.78	23.56 ± 1.52	1.496	0.135

指标	观察组（n = 213）	对照组（n = 213）	t值	P值
动脉期强化差值	28.38 ± 8.81	19.72 ± 6.48	11.557	< 0.001
静脉期强化差值	40.07 ± 13.28	49.09 ± 14.04	6.812	< 0.001
SPARCL1 mRNA	0.20 ± 0.06	0.28 ± 0.09	10.794	< 0.001
VEGF/（pg/mL）	237.37 ± 70.16	176.32 ± 57.57	9.809	< 0.001
TK-1/（pmol/L）	3.79 ± 1.27	2.66 ± 0.72	11.297	< 0.001

指标	敏感度/%	特异度/%	AUC	95%CI	截断值	P值
动脉期强化差值	68.54	79.81	0.796^*	0.755 ~ 0.834	> 25.60	< 0.001
静脉期强化差值	81.22	60.00	0.749^*	0.705 ~ 0.790	≤ 48.09	< 0.001
SPARCL1 mRNA	77.93	63.38	0.750^*	0.707 ~ 0.791	≤ 0.24	< 0.001
VEGF/（pg/mL）	60.09	80.23	0.740^*	0.696 ~ 0.781	> 212.46	< 0.001
TK-1/（pmol/L）	64.79	84.51	0.778^*	0.736 ~ 0.817	> 3.40	< 0.001
联合	76.06	81.22	0.873	0.837 ~ 0.903	> 0.42	< 0.001

因素	预后不良组（n = 53）	预后良好组（n = 156）	χ² /t值	P值
年龄（x ± s）/岁	61.18 ± 4.15	59.98 ± 5.38	1.480	0.140
性别			0.442	0.506
男	33（62.26）	89（57.05）
女	20（37.74）	67（42.95）
BMI（x ± s）/（kg/m²）	23.91 ± 1.35	23.79 ± 1.22	0.602	0.548
分化程度			10.094	0.001
低分化	30（56.60）	50（32.05）
中高分化	23（43.40）	106（67.95）
肿瘤分期			11.960	0.001
Ⅰ—Ⅱ期	32（60.38）	130（83.33）
Ⅲ—Ⅳ期	21（39.62）	26（16.67）
肿瘤最大径			0.091	0.762
< 3 cm	30（56.60）	92（58.97）
≥ 3 cm	23（43.40）	64（41.03）
静脉侵犯	16（30.19）	45（28.85）	0.034	0.853
淋巴结转移	24（45.28）	40（25.64）	7.184	0.007
动脉期强化差值（x ± s）	34.38 ± 11.08	27.67 ± 8.78	4.485	< 0.001
静脉期强化差值（x ± s）	33.37 ± 11.01	48.29 ± 15.30	6.542	< 0.001
SPARCL1 mRNA（x ± s）	0.18 ± 0.05	0.26 ± 0.08	5.833	< 0.001
VEGF（x ± s）/（pg/mL）	255.37 ± 77.46	183.33 ± 58.24	7.118	< 0.001
TK-1（x ± s）/（pmol/L)	3.89 ± 1.21	2.85 ± 0.92	6.536	< 0.001

自变量	赋值方法
分化程度	0 =中高分化，1 =低分化
肿瘤分期	0 = Ⅰ—Ⅱ期，1 = Ⅲ—Ⅳ期
淋巴结转移	0=无，1=有
动脉期强化差值	0 = ≤截断值（低强化），1 = >截断值（高强化）
静脉期强化差值	0 = ≥截断值（高强化），1 = <截断值（低强化）
SPARCL1 mRNA	0 = ≥截断值，1 = <截断值
VEGF/（pg/mL）	0 = ≤截断值，1 = >截断值
TK-1/（pmol/L）	0 = ≤截断值，1 = >截断值

Diagnostic and prognostic value of enhanced CT combined with SPARCL1， VEGF， and TK-1 in primary liver cancer

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影响因素	β	SE	Wald χ²	P值	OR	95%CI
分化程度	1.189	0.283	17.652	< 0.001	3.284	1.886 ~ 5.718
肿瘤分期	1.027	0.322	10.173	0.001	2.793	1.486 ~ 5.249
淋巴结转移	0.994	0.404	6.054	0.014	2.702	1.224 ~ 5.965
动脉期强化差值	0.994	0.422	5.548	0.019	2.702	1.182 ~ 6.179
静脉期强化差值	-0.969	0.356	7.409	0.006	0.379	0.189 ~ 0.762
SPARCL1 mRNA	-1.021	0.443	5.312	0.021	0.360	0.151 ~ 0.858
VEGF/（pg/mL）	0.885	0.326	7.370	0.007	2.423	1.279 ~ 4.590
TK-1/（pmol/L）	0.852	0.315	7.316	0.007	2.344	1.264 ~ 4.347

指标	敏感度/%	特异度/%	AUC	95%CI	截断值	P值
分化程度	56.60	67.90	0.623^*	0.534 ~ 0.711	> 0.50	0.008
肿瘤分期	60.40	83.80	0.719^*	0.633 ~ 0.804	> 0.50	< 0.001
淋巴结转移	50.90	74.40	0.627^*	0.537 ~ 0.716	> 0.50	0.006
动脉期强化差值	64.15	72.44	0.726^*	0.660 ~ 0.785	> 31.10	< 0.001
静脉期强化差值	83.02	67.31	0.813^*	0.753 ~ 0.863	≤ 42.94	< 0.001
SPARCL1 mRNA	73.58	76.92	0.820^*	0.761 ~ 0.870	≤ 0.22	< 0.001
VEGF/（pg/mL）	69.81	77.56	0.765^*	0.702 ~ 0.821	> 226.56	< 0.001
TK-1/（pmol/L）	64.15	75.00	0.709^*	0.642 ~ 0.769	> 3.28	< 0.001
联合	81.13	82.69	0.905	0.857 ~ 0.941	> 0.44	< 0.001

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