Yamamoto Kentaroh, Imamura Hiroshi, Matsuyama Yutaka, Hasegawa Kiyoshi, Beck Yoshifumi, Sugawara Yasuhiko, Makuuchi Masatoshi, Kokudo Norihiro
Department of Surgery, Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, University of Tokyo, Tokyo, Japan.
Ann Surg Oncol. 2009 Oct;16(10):2795-804. doi: 10.1245/s10434-009-0618-y. Epub 2009 Aug 11.
Alpha-fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP) are well-known tumor markers of hepatocellular carcinoma (HCC). The aims of this study are to calculate the sensitivity/specificity of AFP and DCP measurement for the diagnosis of HCC, measure response rates of the markers following curative-intent resections, determine the correlations between the marker levels and clinicopathological prognostic variables, and determine the correlations between the marker levels before hepatectomy and those at diagnosis of recurrence.
A retrospective cohort study of 714 consecutive patients with HCC undergoing hepatectomy was carried out.
The areas under the receiver operating characteristic curves were 0.79 versus 0.91 for AFP and DCP, respectively (P < 0.001). Positive AFP and DCP status became negative at 6 months post surgery in 184/229 (80.3%) and 245/246 (99.6%) patients, respectively (cutoff values being 20 ng/ml for AFP and 40 mAU/ml for DCP; P < 0.0001). No correlation was found between marker levels (rs = 0.23). The level of DCP, but not that of AFP, showed a close correlation with tumor size (rs = 0.51 and 0.19, respectively). They were associated with indices of tumor invasiveness without showing any specific associations. AFP and DCP levels in patients showing recurrence in </=6 months correlated with the levels measured before surgery (rs = 0.78 and 0.49, respectively) but not in those showing recurrence after 2 years (rs = 0.31 and 0.30, respectively).
DCP is a more accurate, albeit complementary, HCC marker than AFP. While the levels of both markers increased with advancing tumor growth, no specific associations were found. The marker values at recurrence indicated the type of recurrence.
甲胎蛋白（AFP）和异常凝血酶原（DCP）是肝细胞癌（HCC）的著名肿瘤标志物。本研究的目的是计算AFP和DCP检测对HCC诊断的敏感性/特异性，测量根治性切除术后标志物的反应率，确定标志物水平与临床病理预后变量之间的相关性，以及确定肝切除术前标志物水平与复发诊断时标志物水平之间的相关性。
对714例连续接受肝切除术的HCC患者进行回顾性队列研究。
AFP和DCP的受试者工作特征曲线下面积分别为0.79和0.91（P<0.001）。术后6个月，分别有184/229例（80.3%）和245/246例（99.6%）患者的AFP和DCP阳性状态转为阴性（AFP的临界值为20 ng/ml，DCP的临界值为40 mAU/ml；P<0.0001）。未发现标志物水平之间存在相关性（rs=0.23）。DCP水平而非AFP水平与肿瘤大小密切相关（rs分别为0.51和0.19）。它们与肿瘤侵袭指标相关，但未显示任何特定关联。在≤6个月内复发的患者中，AFP和DCP水平与术前测量的水平相关（rs分别为0.78和0.49），但在2年后复发的患者中则不相关（rs分别为0.31和0.30）。
DCP是一种比AFP更准确的HCC标志物，尽管是互补性的。虽然两种标志物的水平都随着肿瘤生长的进展而升高，但未发现特定关联。复发时的标志物值表明了复发类型。
