Arrigoni A, Andriulli A, Gindro T, Piantino P, Capussotti L, Rizzetto M
Division of Medicine, Santo Spirito Hospital, Bra (To), Italy.
Int J Biol Markers. 1988 Jul-Sep;3(3):172-6. doi: 10.1177/172460088800300305.
In a surveillance program for hepatocellular carcinoma (HCC), serum alpha-fetoprotein (AFP) was determined every 4 months in 164 patients with liver cirrhosis. Ultrasonography (US) was performed yearly or as dictated by abnormal AFP levels. During a follow-up of 32.5 +/- 20.8 months HCC was identified by US in 16 patients. In 9 of them the AFP levels rose steadily over 4 months, increasing 7, 8 and 12 months in 3 cases before the lesion became detectable by US. In 4 patients tumors developed despite persistently normal AFP levels. Nine more patients showed abnormal fluctuations of AFP but HCC was not detected. AFP sensitivity was higher at a low cut-off point (40 ng/ml) while specificity of the test appeared higher at the 200 ng/ml cut-off point. An AFP value rising steeply over a few months appeared more reliable than a fixed preset threshold in indicating carcinomatous transformation. Screening for AFP can be expected to uncover about 3/4 of HCC developing in cirrhotics with few false-positive reactions. The test may have a unique role in identifying a subset of liver tumors whose early expression is AFP production.
在一项肝细胞癌（HCC）监测项目中，对164例肝硬化患者每4个月测定一次血清甲胎蛋白（AFP）。每年进行超声检查（US），或根据AFP水平异常情况随时检查。在32.5±20.8个月的随访期间，通过超声检查在16例患者中发现了肝癌。其中9例患者的AFP水平在4个月内持续上升，在3例患者中，病变在超声检查可检测到之前的7、8和12个月时AFP水平升高。4例患者尽管AFP水平持续正常仍发生了肿瘤。另外9例患者AFP出现异常波动，但未检测到肝癌。AFP在低临界值（40 ng/ml）时敏感性较高，而在临界值为200 ng/ml时检测的特异性似乎更高。在提示癌变方面，几个月内急剧上升的AFP值似乎比固定的预设阈值更可靠。预计筛查AFP可发现约3/4在肝硬化患者中发生的肝癌，假阳性反应很少。该检测在识别早期表达AFP的一部分肝肿瘤方面可能具有独特作用。
