[血清甲胎蛋白水平对原发性肝细胞癌R0切除术后短期复发的影响]
[Impact of serum α-fetoprotein level on short-term recurrence after R0 resection in primary hepatocellular carcinoma].
作者信息
Li Song-peng, Wu Li-qun
机构信息
Department of Hepatobiliary Surgery, the Affiliated Hospital of Medical College Qingdao University, Qingdao 266003, China.
出版信息
Zhonghua Wai Ke Za Zhi. 2013 Jul;51(7):600-3.
OBJECTIVE
To investigate the impact of serum α-fetoprotein (AFP) level on survival and short-term recurrence after R0 resection in primary hepatocellular carcinoma (HCC).
METHODS
The clinical data of 582 cases of primary HCC underwent R0 resection from January 1997 to December 2009 was analyzed retrospectively. There were 488 male and 94 female patients whose average age was 51 years (ranging from 31 to 73 years). The survival rate of 1-, 3- and 5-year and clinopathological factors between the AFP-negative group and AFP-positive group were compared. The risk factors of short-term recurrence after R0 resection of HCC patients in AFP-positive group were further analyzed.
RESULTS
The age and histological differentiation in AFP-positive group were significantly lower than the AFP-negative group (χ(2) = 11.004, 32.293; P = 0.000). Otherwise the serum γ-glutamyl transferase level, diameter of tumor, TNM stage and short-term recurrence were higher than the AFP-negative group (χ(2) = 9.814 to 14.009, P < 0.05) , and solitary HCC in AFP-positive group was less than AFP-negative group (χ(2) = 8.509, P = 0.004). Survival analysis showed that overall survival rate of 1-, 3- and 5- year were 80.5%, 53.9%, 40.2% and 89.2%, 69.8%, 50.3% in the AFP-positive group and AFP-negative group, respectively (χ(2) = 11.884, P = 0.001), and the disease-free survival rate of 1-, 3- and 5- year were 65.6%, 38.4%, 29.6% and 81.7%, 51.0%, 42.1% (χ(2) = 15.574, P = 0.000). The median overall survival time of short-term recurrence and not short-term recurrence were 10 months and 62 months, respectively (χ(2) = 45.013, P = 0.000). The median survival time from recurrence to death were 6 months and 14 months, respectively (χ(2) = 40.581, P = 0.000). Multiple-factor analysis suggested that non-solitary HCC and histological low differentiation are independent risk factors which influence short-term recurrence of HCC patients.
CONCLUSION
The increase of preoperative serum AFP level suggests the potency of HCC short-term recurrency.
目的
探讨血清甲胎蛋白（AFP）水平对原发性肝细胞癌（HCC）R0切除术后生存及短期复发的影响。
方法
回顾性分析1997年1月至2009年12月行R0切除的582例原发性HCC患者的临床资料。男性488例，女性94例，平均年龄51岁（31~73岁）。比较AFP阴性组和AFP阳性组的1年、3年和5年生存率及临床病理因素。进一步分析AFP阳性组HCC患者R0切除术后短期复发的危险因素。
结果
AFP阳性组患者年龄及组织学分化程度显著低于AFP阴性组（χ(2)=11.004，32.293；P=0.000）。血清γ-谷氨酰转移酶水平、肿瘤直径、TNM分期及短期复发率高于AFP阴性组（χ(2)=9.814至14.009，P<0.05），AFP阳性组孤立性HCC少于AFP阴性组（χ(2)=8.509，P=0.004）。生存分析显示，AFP阳性组和AFP阴性组的1年、3年和5年总生存率分别为80.5%、53.9%、40.2%和89.2%、69.8%、50.3%（χ(2)=11.884，P=0.001），1年、3年和5年无病生存率分别为65.6%、38.4%、29.6%和81.7%、51.0%、42.1%（χ(2)=15.574，P=0.000）。短期复发和未短期复发患者的中位总生存时间分别为10个月和62个月（χ(2)=45.013，P=0.000）。复发至死亡的中位生存时间分别为6个月和14个月（χ(2)=40.581，P=0.000）。多因素分析提示，非孤立性HCC及组织学低分化是影响HCC患者短期复发的独立危险因素。
结论
术前血清AFP水平升高提示HCC短期复发可能性大。
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