Mailey Brian, Artinyan Avo, Khalili Joshua, Denitz Jordan, Sanchez-Luege Nicelio, Sun Can-Lan, Bhatia Smita, Nissen Nicholas, Colquhoun Steven D, Kim Joseph
Department of Oncologic Surgery, City of Hope, Duarte, CA, USA.
Arch Surg. 2011 Jan;146(1):26-33. doi: 10.1001/archsurg.2010.295.
An elevated serum α-fetoprotein (AFP) level before orthotopic liver transplant (OLT) is predictive of mortality after OLT for hepatocellular carcinoma (HCC).
Retrospective analysis of a population-based cohort.
United Network for Organ Sharing registry (2003-2008).
We identified 2253 patients who underwent OLT for HCC with available pre-OLT serum AFP values.
Patients were stratified by AFP levels into low (<20 ng/mL), medium (20-399 ng/mL), or high (≥400 ng/mL) groups. Clinical and pathological characteristics were compared among groups. Survival curves were constructed by the Kaplan-Meier method, and univariate and multivariate Cox-regression analysis was performed.
Of the 2253 patients, 1210 (53.7%), 805 (35.7%), and 238 (10.6%) were in the low, medium, and high AFP groups, respectively. On univariate analysis, the low AFP group demonstrated the best 4-year survival (76%) compared with the medium (65%; P = .001) and high (57%; P < .001) AFP groups. When AFP levels in patients with only stage II HCC underwent assessment, improved survival in the low AFP group was still observed (P < .001). On multivariate analysis, the medium and high AFP groups were associated with higher mortality (hazard ratios, 1.50 [95% confidence interval, 1.19-1.89; P = .001] and 2.11 [1.55-2.88; P < .001], respectively).
Serum AFP level is an independent prognostic predictor of outcome after OLT for HCC. The association between serum AFP value and post-OLT survival warrants further investigation to potentially better allocate donor allografts for HCC.
原位肝移植（OLT）前血清甲胎蛋白（AFP）水平升高可预测肝细胞癌（HCC）患者OLT后的死亡率。
基于人群队列的回顾性分析。
器官共享联合网络登记处（2003 - 2008年）。
我们确定了2253例接受OLT治疗HCC且有OLT前血清AFP值的患者。
根据AFP水平将患者分为低（<20 ng/mL）、中（20 - 399 ng/mL）或高（≥400 ng/mL）组。比较各组的临床和病理特征。采用Kaplan-Meier法构建生存曲线，并进行单因素和多因素Cox回归分析。
2253例患者中，低、中、高AFP组分别有1210例（53.7%）、805例（35.7%）和238例（10.6%）。单因素分析显示，低AFP组4年生存率最佳（76%），优于中AFP组（65%；P = 0.001）和高AFP组（57%；P < 0.001）。对仅II期HCC患者的AFP水平进行评估时，仍观察到低AFP组生存率提高（P < 0.001）。多因素分析显示，中、高AFP组与较高死亡率相关（风险比分别为1.50 [95%置信区间，1.19 - 1.89；P = 0.001]和2.11 [1.55 - 2.88；P < 0.001]）。
血清AFP水平是HCC患者OLT后预后的独立预测指标。血清AFP值与OLT后生存之间的关联值得进一步研究，以潜在地更好地为HCC分配供体同种异体移植物。
