Dipartimento di Medicina Interna, Unità di Gastroenterologia, Università di Genova, Italy.
Hepatology. 2012 Oct;56(4):1371-9. doi: 10.1002/hep.25814.
Alpha-fetoprotein is a tumor marker that has been used for surveillance and diagnosis of hepatocellular carcinoma (HCC) in patients with cirrhosis. The prognostic capability of this marker in patients with HCC has not been clearly defined. In this study our aim was to evaluate the prognostic usefulness of serum alpha-fetoprotein in patients with well-compensated cirrhosis, optimal performance status, and small HCC identified during periodic surveillance ultrasound who were treated with curative intent. Among the 3,027 patients included in the Italian Liver Cancer study group database, we selected 205 Child-Pugh class A and Eastern Cooperative Group Performance Status 0 patients with cirrhosis with a single HCC ≤ 3 cm of diameter diagnosed during surveillance who were treated with curative intent (hepatic resection, liver transplantation, percutaneous ethanol injection, radiofrequency thermal ablation). Patients were subdivided according to alpha-fetoprotein serum levels (i.e., normal ≤ 20 ng/mL; mildly elevated 21-200 ng/mL; markedly elevated >200 ng/mL). Patient survival, as assessed by the Kaplan-Meier method, was not significantly different among the three alpha-fetoprotein classes (P = 0.493). The same result was obtained in the subgroup of patients with a single HCC ≤ 2 cm (P = 0.714). An alpha-fetoprotein serum level of 100 ng/mL identified by receiver operating characteristic curve had inadequate accuracy (area under the curve = 0.536, 95% confidence interval = 0.465-0.606) to discriminate between survivors and deceased patients.
Alpha-fetoprotein serum levels have no prognostic meaning in well-compensated cirrhosis patients with single, small HCC treated with curative intent.
甲胎蛋白是一种肿瘤标志物，已用于肝硬化患者肝细胞癌（HCC）的监测和诊断。该标志物在 HCC 患者中的预后能力尚未明确界定。在这项研究中，我们的目的是评估血清甲胎蛋白在接受根治性治疗的代偿良好的肝硬化、最佳表现状态和在定期超声监测中发现的小 HCC 患者中的预后价值。在意大利肝癌研究组数据库中纳入的 3027 名患者中，我们选择了 205 名 Child-Pugh 分级 A 和东部合作肿瘤组表现状态 0 的肝硬化患者，这些患者在监测期间被诊断为单个 HCC 直径≤3cm，并接受了根治性治疗（肝切除术、肝移植、经皮乙醇注射、射频热消融）。患者根据甲胎蛋白血清水平（即正常≤20ng/ml；轻度升高 21-200ng/ml；显著升高>200ng/ml）进行分组。Kaplan-Meier 法评估的患者生存率在三组甲胎蛋白中无显著差异（P=0.493）。在单个 HCC≤2cm 的亚组中也得到了相同的结果（P=0.714）。通过接收者操作特征曲线确定的甲胎蛋白血清水平为 100ng/ml 时，其准确性不足（曲线下面积为 0.536，95%置信区间为 0.465-0.606），无法区分存活和死亡患者。
在接受根治性治疗的代偿良好的肝硬化伴单个小 HCC 患者中，甲胎蛋白血清水平无预后意义。
