肝细胞肝癌患者术前血清甲胎蛋白水平与肝切除预后间的关系

Preoperative serum α-fetoprotein and prognosis after hepatectomy for hepatocellular carcinoma
2016-10-28 14:57发表评论
作者:Yang, S.-L., Liu, L.-P., Yang, S., Liu, L., Ren, J.-W., Fang, X., Chen, G.G. , Lai, P.B.S.
机构: 香港中文大学威尔斯亲王医院外科
期刊: BRIT J SURG2016年6月6期103卷

Background While the majority of studies report that a raised serum α-fetoprotein (AFP) level before operation is associated with a high risk of recurrence and death in patients who undergo hepatectomy for hepatocellular carcinoma (HCC), results are conflicting. The aim of this study was to assess the prognostic value of AFP. Methods Serum AFP levels were measured in patients with hepatitis-associated HCC who underwent hepatectomy between 1995 and 2012. Kaplan-Meier and multivariable analyses were performed to identify risk factors for overall and disease-free survival. Univariable and multivariable Cox proportional hazards regression was used to evaluate the predictive value of AFP. Receiver operating characteristic (ROC) curves were generated to identify the AFP level that had the highest accuracy in discriminating between survivors and non-survivors. Results Some 376 patients with hepatitis B virus (HBV)-associated HCC were included in the study. The overall survival rate was 58·8 per cent in patients with an AFP level of 400 ng/ml or less compared with 40·4 per cent for those with a level exceeding 400 ng/ml (P = 0·001). AFP concentration above 400 ng/ml was an independent risk factor for shorter disease-free and overall survival after surgery. ROC analysis indicated that the optimal cut-off values for AFP varied for different subtypes of HCC. The sensitivity and specificity were lower with areas under the ROC curve of less than 0·600. An AFP level greater than 400 ng/ml was not sensitive enough to predict the prognosis in patients with an HCC diameter smaller than 3 cm. Conclusion A serum AFP level above 400 ng/ml predicts poor overall and recurrence-free survival after hepatectomy in patients with HBV-associated HCC. AFP is not a strong prognostic marker given its poor discriminatory power, with low sensitivity and specificity. © 2016 BJS Society Ltd Published by John Wiley & Sons Ltd.

通讯机构:Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
学科代码:外科学 整形外科学   关键词:肝细胞肝癌患者 术前 血清甲胎蛋白 ,中国作者重要发表 爱思唯尔医学网, Elseviermed
来源: Scopus
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