Tsugawa Daisuke, Fukumoto Takumi, Kido Masahiro, Takebe Atsushi, Tanaka Motofumi, Kuramitsu Kaori, Matsumoto Ippei, Ajiki Tetsuo, Koyama Tatsuki, Ku Yonson
Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Japan.
Department of Biostatistics, Vanderbilt University School of Medicine, USA.
Kobe J Med Sci. 2015 Mar 7;61(5):E124-31.
Alpha-fetoprotein (AFP) and des-γ-carboxy prothrombin (DCP) are frequently used as tumor markers in hepatocellular carcinoma (HCC). The authors hypothesized different patient populations with varying tumor sizes would influence the predictive power of tumor markers for survival in HCC patients. The authors investigated the influence of tumor size on predictive powers of AFP and DCP. 181 patients underwent hepatectomy for HCC from 2003 to 2008 at Kobe University Hospital. Tumor markers were measured before and at 1 month post-hepatectomy. The Cox proportional-hazards model revealed that preoperative serum AFP was associated with survival; its effects depended on tumor size. Hazard ratios (HRs) for preoperative AFP were maximum for medium-sized HCC, and for DCP, HRs were maximum in small-sized tumors. Post-hepatectomy, both tumor markers were associated with survival, revealing significant interactions with tumor size. HRs for postoperative AFP were greater than 1 for relatively wide range tumors (3-11 cm). HRs for postoperative DCP increased with tumor size, with a strong prognostic predictive power for tumors >5 cm. The predictive power of serum tumor markers varied by tumor size in HCC patients. By selecting the appropriate tumor marker, its predictive power can be improved.
甲胎蛋白（AFP）和脱γ-羧基凝血酶原（DCP）常被用作肝细胞癌（HCC）的肿瘤标志物。作者推测，不同肿瘤大小的患者群体可能会影响肿瘤标志物对HCC患者生存的预测能力。作者研究了肿瘤大小对AFP和DCP预测能力的影响。2003年至2008年期间，181例患者在神户大学医院接受了HCC肝切除术。在肝切除术前及术后1个月测量肿瘤标志物。Cox比例风险模型显示，术前血清AFP与生存相关；其影响取决于肿瘤大小。对于中等大小的HCC，术前AFP的风险比（HRs）最高，而对于DCP，小尺寸肿瘤的HRs最高。肝切除术后，两种肿瘤标志物均与生存相关，显示出与肿瘤大小的显著相互作用。对于相对较大范围的肿瘤（3 - 11厘米），术后AFP的HRs大于1。术后DCP的HRs随肿瘤大小增加，对>5厘米的肿瘤具有较强的预后预测能力。HCC患者血清肿瘤标志物的预测能力因肿瘤大小而异。通过选择合适的肿瘤标志物，可以提高其预测能力。
