Gastroenterology Unit, Department of Internal Medicine, IRCCS-University Hospital San Martino-IST, University of Genoa, Genoa, Italy.
Cancer. 2014 Jul 15;120(14):2150-7. doi: 10.1002/cncr.28706. Epub 2014 Apr 10.
α-Fetoprotein (AFP) is a biomarker commonly used in the management of patients with hepatocellular carcinoma (HCC), although the possible determinants of its serum levels in these patients have not been adequately explored. For this study, the authors evaluated the relevance of demographic, clinical, and oncologic factors to the presence of elevated AFP levels in large cohort of patients with HCC.
In 4123 patients with HCC who were managed by the Italian Liver Cancer Group, AFP levels were assessed along with their association with demographic, biochemical, clinical, and oncologic characteristics. Patients were subdivided according to the presence of elevated AFP (ie, >10 ng/mL).
AFP levels were elevated in 62.4% of patients with HCC. Multivariate logistic regression analysis indicated that being a woman (odds ratio [OR], 1.497; 95% confidence interval [95%CI], 1.250-1.793; P < .0001), the presence of cirrhosis (OR, 1.538; 95% CI, 1.050-2.254; P = .027), liver disease with viral etiology (OR, 1.900; 95% CI, 1.589-2.272; P < .0001), an elevated alanine aminotransferase level (OR, 1.878; 95% CI, 1.602-2.202; P < .0001), a low albumin level (OR, 1.301; 95% CI, 1.110-1.525; P = .012), an HCC tumor size >2 cm (OR, 1.346; 95% CI, 1.135-2.596; P = .001), multinodular HCC (OR, 1.641; 95% CI, 1.403-1.920; P < .0001), and the presence of vascular invasion (OR, 1.774; 95% CI, 1.361-2.311; P < .0001) were associated independently with elevated levels of AFP. Both the median AFP level and the proportion of patients who had elevated levels increased with decreasing degrees of HCC differentiation (P < .0001).
Sex and features of chronic liver disease were identified as nontumor characteristics that influence serum AFP levels in patients with HCC. These findings should be taken into account as limitations in interpreting the oncologic meaning of this biomarker in clinical practice.
甲胎蛋白（AFP）是一种常用于肝细胞癌（HCC）患者管理的生物标志物，尽管尚未充分探讨其在这些患者血清水平中的可能决定因素。为此，作者评估了人口统计学、临床和肿瘤学因素与 HCC 大队列患者中 AFP 水平升高的相关性。
在意大利肝癌小组管理的 4123 名 HCC 患者中，评估了 AFP 水平及其与人口统计学、生化、临床和肿瘤学特征的关联。根据 AFP 升高（即 >10ng/mL）的存在，将患者分为两组。
62.4%的 HCC 患者 AFP 水平升高。多变量逻辑回归分析表明，女性（比值比[OR]，1.497；95%置信区间[95%CI]，1.250-1.793；P<.0001）、肝硬化（OR，1.538；95%CI，1.050-2.254；P=0.027）、病毒性病因的肝病（OR，1.900；95%CI，1.589-2.272；P<.0001）、丙氨酸氨基转移酶水平升高（OR，1.878；95%CI，1.602-2.202；P<.0001）、低白蛋白水平（OR，1.301；95%CI，1.110-1.525；P=0.012）、HCC 肿瘤大小>2cm（OR，1.346；95%CI，1.135-2.596；P=0.001）、多结节 HCC（OR，1.641；95%CI，1.403-1.920；P<.0001）和血管侵犯（OR，1.774；95%CI，1.361-2.311；P<.0001）与 AFP 水平升高独立相关。随着 HCC 分化程度的降低，中位 AFP 水平和 AFP 水平升高患者的比例均升高（P<.0001）。
性别和慢性肝病特征被确定为影响 HCC 患者血清 AFP 水平的非肿瘤特征。在临床实践中解释该生物标志物的肿瘤学意义时，应考虑这些发现的局限性。
