Li Li, Chen Jinglong, Xu Weiran, Ding Xiaosheng, Wang Xiangyi, Liang Jun
Department of Oncology, Peking University International Hospital, Beijing, China.
Department of Oncology, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
Asia Pac J Clin Oncol. 2018 Oct;14(5):e336-e340. doi: 10.1111/ajco.12816. Epub 2017 Oct 26.
Serum alpha-fetoprotein (AFP) level is normal in 30-40% of hepatocellular carcinoma (HCC) patients, and knowledge on its characteristics and clinical outcome is limited. The purpose of this observational study was to determine the clinical presentation, biological behavior and outcome of HCC patients with normal AFP level.
Data of 112 consecutive HCC patients with normal AFP level were analyzed retrospectively. Statistical analysis including survival and factors associated with serum AFP level were performed by Kaplan-Meier method and t-test, respectively.
Hepatitis B virus infection exited in 83.0% of all 112 HCC patients with normal AFP level. During a mean 52 ± 20 months (range 5-85 months) follow-up, the 1-, 2-, 3-year overall survival (OS) rate was 97.2%, 85.3% and 81.7%, respectively. The OS rates at 3 years stratified by stages at diagnosis were 100%, 96.2%, 85.7%, 11.1% and 0%, respectively for Barcelona Clinic Liver Cancer (BCLC) stage 0-D diseases. Significant difference in OS was observed among patients with BCLC stage 0-D diseases, P < 0.05. Using 8.78 ng/mL as the cut off value, serum AFP level elevated beyond normal figure during follow-up (AFP conversion) in 16 patients, which related with deterioration of liver function, quantitative changes of T helper cell subsets, rapid tumor progression and shorter survival. Patients with sustained normal AFP level had better survival than patients with AFP conversion, P < 0.05. There was significant difference between the time of diagnosis with HCC to serum AFP level elevation and the time of AFP elevation to death, P < 0.05.
Prognosis of HCC patients with normal AFP level was relatively optimal. Serum AFP level elevation during follow-up was significantly associated with clinical outcome in terms of OS.
30%-40%的肝细胞癌（HCC）患者血清甲胎蛋白（AFP）水平正常，关于其特征和临床结局的认识有限。本观察性研究的目的是确定AFP水平正常的HCC患者的临床表现、生物学行为和结局。
回顾性分析112例连续的AFP水平正常的HCC患者的数据。分别采用Kaplan-Meier法和t检验进行生存分析以及与血清AFP水平相关因素的分析。
112例AFP水平正常的HCC患者中，83.0%存在乙型肝炎病毒感染。在平均52±20个月（范围5-85个月）的随访期间，1年、2年、3年总生存率（OS）分别为97.2%、85.3%和81.7%。巴塞罗那临床肝癌（BCLC）0-D期疾病患者3年OS率分别为100%、96.2%、85.7%、11.1%和0%。BCLC 0-D期疾病患者的OS存在显著差异，P<0.05。以AFP 8.78 ng/mL为临界值，16例患者随访期间血清AFP水平升高超过正常范围（AFP转化），这与肝功能恶化、辅助性T细胞亚群定量变化、肿瘤快速进展及生存期缩短相关。AFP水平持续正常的患者比AFP转化的患者生存期更长，P<0.05。HCC诊断至血清AFP水平升高以及AFP升高至死亡的时间存在显著差异，P<0.05。
AFP水平正常的HCC患者预后相对较好。随访期间血清AFP水平升高与OS方面的临床结局显著相关。
