Okamura Yukiyasu, Ashida Ryo, Ito Takaaki, Sugiura Teiichi, Mori Keita, Uesaka Katsuhiko
Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan.
Clinical Trial Coordination Office Biostatistician, Shizuoka Cancer Center Hospital, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan.
Surg Today. 2015 Dec;45(12):1513-20. doi: 10.1007/s00595-014-1102-2. Epub 2014 Dec 20.
Alpha-fetoprotein (AFP) and des-γ-carboxy prothrombin (DCP) are prognostic factors for hepatocellular carcinoma (HCC). The impact of these tumor markers in recurrent HCC on the prognosis remains to be fully elucidated.
Two hundred and seventeen patients whose AFP and DCP levels were measured at recurrence were enrolled in the present study. AFP levels >10 ng/mL and DCP levels ≥40 mAU/mL were defined as AFP positive (AFP+) and DCP positive (DCP+), respectively. The patterns of tumor markers were scored as AFP-/DCP-, 0; AFP+/DCP- or AFP-/DCP+, 1 and AFP+/DCP+, 2.
The median survival period after recurrence in patients with a score of 2 (26.6 months) was significantly lower than that in patients with scores of 1 or 0 (43.5 months, P < 0.01; 75.3 months, P < 0.01, respectively). A multivariate analysis showed that a tumor marker score of 2 at recurrence was an independent predictor for poor survival after recurrence (hazard ratio 2.12, P = 0.03). The prognosis after recurrence in the patients with a decreased tumor maker score was significantly better than that in the patients with no change in the tumor marker score compared to the primary surgery (P = 0.048).
The present study shows that measurements of both AFP and DCP are useful for predicting the prognosis of recurrent HCC.
甲胎蛋白（AFP）和脱γ-羧基凝血酶原（DCP）是肝细胞癌（HCC）的预后因素。这些肿瘤标志物在复发性HCC中对预后的影响仍有待充分阐明。
本研究纳入了217例复发时检测AFP和DCP水平的患者。AFP水平>10 ng/mL和DCP水平≥40 mAU/mL分别定义为AFP阳性（AFP+）和DCP阳性（DCP+）。肿瘤标志物模式评分为AFP-/DCP-，0分；AFP+/DCP-或AFP-/DCP+，1分；AFP+/DCP+，2分。
评分为2分的患者复发后的中位生存期（26.6个月）显著低于评分为1分或0分的患者（分别为43.5个月，P<0.01；75.3个月，P<0.01）。多因素分析显示，复发时肿瘤标志物评分为2分是复发后生存不良的独立预测因素（风险比2.12，P=0.03）。与初次手术相比，肿瘤标志物评分降低的患者复发后的预后明显好于肿瘤标志物评分无变化的患者（P=0.048）。
本研究表明，检测AFP和DCP均有助于预测复发性HCC的预后。
