Yao Mingjie, Zhao Jingmin, Lu Fengmin
State Key Laboratory of Natural and Biomimetic Drugs, Department of Microbiology and Infectious Disease Center, School of Basic Medicine, Peking University Health Science Center, Beijing, China.
Department of Pathology and Hepatology, Beijing 302 Hospital, Beijing, China.
Oncotarget. 2016 Jan 26;7(4):3702-8. doi: 10.18632/oncotarget.6913.
Use of serum alpha-fetoprotein (AFP) in clinical practices has been challenged in recent years, due to the lack of specificity and sensitivity. Here we conducted a retrospective study to evaluate the diagnostic and prognostic value of serum AFP among hepatocellular carcinoma (HCC) patients with their pathogenic features taken into consideration. The cohort for this study comprised 318 cases of hepatitis and 731 cases of cirrhosis, as well as 796 HCC patients. Using 11.62ng/mL as a cut-off value, the positive rate of AFP test among serum hepatitis B surface antigen (HBsAg) positive HCC patients was significantly higher than that in those HBsAg negative HCC patients (79.55% vs 56.49%, P < 0.000). Similarly, the median serum AFP level in HCC patients with serum HBsAg positive was significantly higher than that in those HBsAg negative HCC patients (423.89ng/ml vs 40.82ng/ml, P < 0.000). In addition, Kaplan-Meier curve analysis revealed that lower preoperative AFP level implicated a much higher overall survival rate. Of note, such prognosis predicting value was only seen in those chronic HBV infection-related HCC patients, but not among the HCC patients etiologically irrelevant to HBV infection. We believe that serum AFP is of diagnosis and prognostic predicting value for HCC with chronic HBV infection, and strongly suggest use of serum AFP as a biomarker in China and other HBV infection endemic area like Southeast Asia.
近年来，由于缺乏特异性和敏感性，血清甲胎蛋白（AFP）在临床实践中的应用受到了挑战。在此，我们进行了一项回顾性研究，以评估血清AFP在考虑致病特征的肝细胞癌（HCC）患者中的诊断和预后价值。本研究队列包括318例肝炎患者、731例肝硬化患者以及796例HCC患者。以11.62ng/mL作为临界值，血清乙型肝炎表面抗原（HBsAg）阳性的HCC患者中AFP检测的阳性率显著高于HBsAg阴性的HCC患者（79.55%对56.49%，P<0.000）。同样，血清HBsAg阳性的HCC患者的血清AFP中位数水平显著高于HBsAg阴性的HCC患者（423.89ng/ml对40.82ng/ml，P<0.000）。此外，Kaplan-Meier曲线分析显示，术前AFP水平较低意味着总体生存率高得多。值得注意的是，这种预后预测价值仅在那些慢性HBV感染相关的HCC患者中可见，而在病因与HBV感染无关的HCC患者中则未观察到。我们认为，血清AFP对慢性HBV感染的HCC具有诊断和预后预测价值，并强烈建议在中国及其他HBV感染流行地区（如东南亚）将血清AFP用作生物标志物。
