ObjectiveTo investigate the value of combined determination of hepatitis C virus (HCV) genotype, the alpha-fetoprotein variant AFP-L3, and P53 antibody in HCV-related hepatocellular carcinoma (HCV-HCC). MethodsA total of 84 patients with HCV-HCC who were diagnosed in our hospital from January 2016 to December 2019 were enrolled as HCV-HCC group, and 84 patients with benign liver diseases (hepatitis C and HCV liver cirrhosis) were enrolled as control group. The PCR-reverse dot blot hybridization technique was used to determine HCV genotype, ELISA was used to measure P53 antibody, and electrochemical luminescence was used to measure AFP-L3. The t-test and the Kruskal-Wallis H test were used for comparison between two groups; the chi-square test was used for comparison of categorical data between two groups. The logistic regression analysis and the receiver operating characteristic (ROC) curve were used to compare the value of each index in the diagnosis of HCV-HCC. ResultsCompared with the control group, the HCV-HCC group had a significantly higher proportion of patients with HCV 1b genotype or AFP-L3 and a significantly higher level of P53 antibody (χ2=5714, Z=-9.27, Z=-9.92, all P＜0.05). The logistic regression analysis showed that HCV genotype, AFP-L3, and P53 antibody had significant effects on HCV-HCC (all P＜0.05). The above indices were fitted to establish a model of Logit(Y)=-3.881+0031XAFP-L3(%)+0.043XP53+1218XHCV genotype, in which Y was the positive probability value of combined determination. In the screening of HCV-HCC, Y had a significantly larger area under the ROC curve than HCV genotype (0.945 vs 0.758, Z=6.17, P＜0001), AFP-L3 (0.945 vs 0.863, Z=3.97, P＜0.001), and P53 antibody (0.945 vs 0.887, Z=3.07, P=0.002). Y had higher AUC (0.945), sensitivity (90.90%), specificity (94.00%), positive predictive value (93.80%), negative predictive value (9116%), and diagnostic accuracy (92.44%) than each index alone. ConclusionHCV 1b genotype, AFP-L3, and P53 antibody level are associated with the risk of HCV-HCC, and the combined determination of the three indices has important clinical significance in the early diagnosis of HCV-HCC.

[摘 要] 目的：探讨同源重组修复（HRR）基因突变对晚期非小细胞肺癌（NSCLC）患者免疫治疗疗效和预后的影响。方法：收集2018年3月至2023年4月间在郑州大学第一附属医院接受PD-1抑制剂治疗的124例晚期NSCLC患者的临床资料。根据有无HRR基因突变将患者分为突变组（n=57例）和野生组（n=67例），采用卡方检验或Fisher’s精确检验比较两组患者的临床特征及免疫治疗疗效差异，采用Kaplan-Meier方法比较两组患者的PFS，采用单因素和多因素Cox回归分析PFS的影响因素。结果：HRR基因突变组中鳞癌及肿瘤突变负荷（TMB）≥10 mut/Mb的占比显著多于野生组（54.4% vs 32.8%，61.4% vs 29.9%，均P<0.05）。HRR基因突变组与野生组患者的ORR分别为17.5%和10.4%（P=0.252），DCR分别为86.0%和73.1%（P=0.080）。HRR基因突变组与野生组的PFS比较差异具有统计学意义（6.8个月 vs 3.9个月，P<0.001）。多因素分析结果显示，有无HRR基因突变[HR=0.550，95%CI（0.352, 0.860）, P=0.009]与免疫治疗线数[HR=0.468，95%CI（0.312, 0.702）, P<0.001]和PFS显著相关。结论：HRR基因突变组患者的免疫治疗疗效优于野生组患者，HRR基因突变是晚期NSCLC患者免疫治疗预后的独立保护因素。