非病毒病因引起的肝细胞癌的治疗前甲胎蛋白——一项前瞻性研究。
Pre-treatment alphafeto protein in hepatocellular carcinoma with non-viral aetiology - a prospective study.
作者信息
Chaminda Siriwardana Rohan, Suchintha Thilakarathne, Anuk Niriella Madunil, Supun Dassanayake Anuradha, Bhagya Gunathilake Mahen, Habarakada Liyanage Chandika Anuruddha, Janaka De Silva Hithadurage
机构信息
Department of surgery, Faculty of Medicine, University of Kelaniya Sri Lanka, Kelaniya, Sri Lanka.
Department of medicine, Faculty of Medicine, University of Kelaniya Sri Lanka, Kelaniya, Sri Lanka.
出版信息
BMC Gastroenterol. 2017 Dec 6;17(1):142. doi: 10.1186/s12876-017-0710-x.
BACKGROUND
Alpha-fetoprotein (AFP) is a biomarker for hepatocellular carcinoma (HCC). The significance of pre-treatment AFP (pt-AFP) in non-viral HCC (nvHCC) is not clear.
METHODS
Patients with nvHCC, referred to a Hepatobiliary Clinic from September 2011-2015 were screened. HCC was diagnosed using American Association for the Study of Liver Disease guidelines, and TNM staged. nvHCC was diagnosed when HBsAg and anti-HCVAb was negative. Child-Turcotte-Pugh (CTP) and Model for End-stage Liver Disease (MELD) scores were calculated. AFP level was evaluated against patient characteristics, tumour characteristics and survival.
RESULTS
Three hundred eighty-nine patients with nvHCC [age 64(12-88) years; 344(88.4%) males] were screened. Median AFP was 25.46 ng/ml (1.16-100,000). 41.2% (n = 160) Of patients had normal AFP level. 22.9% (n = 89) had AFP over 400 ng/ml. Female gender (P < 0.05), vascular invasion (P < 0.001), tumours over 5 cm (P < 0.05), late TNM stage (P < 0.001) and non-surgical candidates had higher AFP levels. Diffuse type (P < 0.001), macro vascular invasion (P < 0.001) and late stage tumours (P < 0.001) had AFP over 400 ng/ml. Having AFP below 400 ng/ml was associated with longer survival (16 vs. 7 months, P < 0.001).
CONCLUSION
Pre treatment AFP has a limited value In diagnosing nvHCC, Having a AFP value over 400 ng/ml was associated with aggressive tumour behaviour and poor prognosis.
背景
甲胎蛋白（AFP）是肝细胞癌（HCC）的一种生物标志物。非病毒性肝细胞癌（nvHCC）中治疗前AFP（pt-AFP）的意义尚不清楚。
方法
对2011年9月至2015年转诊至肝胆科门诊的nvHCC患者进行筛查。采用美国肝病研究协会指南诊断HCC，并进行TNM分期。当HBsAg和抗HCVAb均为阴性时诊断为nvHCC。计算Child-Turcotte-Pugh（CTP）和终末期肝病模型（MELD）评分。根据患者特征、肿瘤特征和生存率评估AFP水平。
结果
筛查了389例nvHCC患者[年龄64（12 - 88）岁；344例（88.4%）为男性]。AFP中位数为25.46 ng/ml（1.16 - 100,000）。41.2%（n = 160）的患者AFP水平正常。22.9%（n = 89）的患者AFP超过400 ng/ml。女性（P < 0.05）、血管侵犯（P < 0.001）、肿瘤直径超过5 cm（P < 0.05）、TNM晚期（P < 0.001）以及非手术候选患者的AFP水平较高。弥漫型（P < 0.001）、大血管侵犯（P < 0.001）和晚期肿瘤（P < 0.001）的AFP超过400 ng/ml。AFP低于400 ng/ml与较长生存期相关（16个月对7个月，P < 0.001）。
结论
治疗前AFP在诊断nvHCC方面价值有限，AFP值超过400 ng/ml与侵袭性肿瘤行为和不良预后相关。
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