Tsukamoto Masayo, Nitta Hidetoshi, Imai Katsunori, Higashi Takaaki, Nakagawa Shigeki, Okabe Hirohisa, Arima Kota, Kaida Takayoshi, Taki Katsunobu, Hashimoto Daisuke, Chikamoto Akira, Ishiko Takatoshi, Beppu Toru, Baba Hideo
Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Hepatol Res. 2018 Feb;48(3):E183-E193. doi: 10.1111/hepr.12942. Epub 2017 Sep 8.
The prognostic significance of the half-lives (HLs) of α-fetoprotein (AFP) and des-γ-carboxy prothrombin (DCP) in patients undergoing hepatectomy for hepatocellular carcinoma (HCC) is unclear. We evaluated the HLs of AFP and DCP in a cohort of such patients.
This study included data on 202 patients with HCC who underwent curative hepatectomy and had preoperative AFP concentrations ≥100 ng/mL or DCP ≥200 mAU/mL. We calculated the HLs of AFP and DCP from their values just before and 1 month after hepatectomy. We identified three groups: a normalization group, tumor marker concentrations within normal range 1 month post-hepatectomy; a long group, HL of AFP ≥7 days or DCP ≥4 days; and a short group, remaining patients. We evaluated associations between HL and prognosis.
Three-year recurrence-free survival (RFS) in the normalization (n = 70), short (n = 71), and long groups (n = 61) was 41.3%, 46.0%, and 16.8%, respectively (P = 0.002). Five-year overall survival (OS) of normalization, short, and long groups was 72.6, 70.6 and 43.8%, respectively (P = 0.002). Multivariate analysis revealed that long HL is an independent risk factor for poor RFS (hazard ratio [HR] 2.21, P = 0.0006) and poor OS (HR 2.70, P = 0.004). The extrahepatic recurrence rate was 21.3% (13/61) in the long group, which is higher than in the normalization group (8.6%, 6/70) (P = 0.04) and short group (9.9%, 7/71) (P = 0.07).
Post-hepatectomy HLs of AFP and DCP are predictors of long-term outcome in patients with HCC.
在接受肝细胞癌（HCC）肝切除术的患者中，甲胎蛋白（AFP）和脱γ-羧基凝血酶原（DCP）半衰期（HLs）的预后意义尚不清楚。我们评估了此类患者队列中AFP和DCP的HLs。
本研究纳入了202例行根治性肝切除术且术前AFP浓度≥100 ng/mL或DCP≥200 mAU/mL的HCC患者的数据。我们根据肝切除术前及术后1个月时AFP和DCP的值计算其HLs。我们将患者分为三组：正常化组，肝切除术后1个月肿瘤标志物浓度在正常范围内；长半衰期组，AFP的HL≥7天或DCP的HL≥4天；短半衰期组，其余患者。我们评估了HL与预后之间的关联。
正常化组（n = 70）、短半衰期组（n = 71）和长半衰期组（n = 61）的3年无复发生存率（RFS）分别为41.3%、46.0%和16.8%（P = 0.002）。正常化组、短半衰期组和长半衰期组的5年总生存率（OS）分别为72.6%、70.6%和43.8%（P = 0.002）。多变量分析显示，长HL是RFS不良（风险比[HR] 2.21，P = 0.0006）和OS不良（HR 2.70，P = 0.004）的独立危险因素。长半衰期组的肝外复发率为21.3%（13/61），高于正常化组（8.6%，6/70）（P = 0.04）和短半衰期组（9.9%，7/71）（P = 0.07）。
肝切除术后AFP和DCP的HLs是HCC患者长期预后的预测指标。
