Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai, China.
Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai, China.
Surgery. 2019 Jun;165(6):1161-1167. doi: 10.1016/j.surg.2019.01.009. Epub 2019 Mar 4.
To investigate the prognostic values of the change of α-fetoprotein within 1 week after resection of hepatocellular carcinoma.
We retrospectively analyzed patients with hepatocellular carcinoma who underwent curative hepatectomy as primary therapy at Zhongshan Hospital, Fudan University (Shanghai, China) from 2009 to 2011. We measured serum α-fetoprotein before (α-fetoprotein) and 1 week after (α-fetoprotein) hepatectomy, calculated change of α-fetoprotein, namely the α-fetoprotein response by the formula: AR = lgAFP/lgAFP (lg = log), analyzed the relationship between patient survival and α-fetoprotein response, and explored the potential clinical implications of the α-fetoprotein response. The results were validated in an independent cohort of patients from the same institute.
A total of 841 eligible patients were analyzed. We determined that the optimal cutoff value of the α-fetoprotein response was 0.8135 and subsequently classified patients from the exploration cohort into the α-fetoprotein responder (α-fetoprotein response ≤ 0.8135; n = 452) and α-fetoprotein nonresponder (α-fetoprotein response > 0.8135; n = 146). Multivariate Cox analysis showed that the α-fetoprotein response independently predicted overall survival (OS) and recurrence-free survival (RFS) time after resection (both P < .001). In patients with a higher risk of tumor recurrence (either single tumor with microvascular invasion or multiple tumors), α-fetoprotein responders were associated with better survival than the nonresponders (P < .05). The results were validated by propensity score matched population and another independent cohort.
The α-fetoprotein response is a reliable and simple predictive marker for evaluating the oncological effect of surgical resection for hepatocellular carcinoma with positive α-fetoprotein before resection, independent of tumor features.
研究肝癌切除术后 1 周内甲胎蛋白变化的预后价值。
我们回顾性分析了 2009 年至 2011 年期间在复旦大学中山医院接受根治性肝切除术作为原发性治疗的肝癌患者。我们在肝切除术前（甲胎蛋白）和术后 1 周（甲胎蛋白）测量血清甲胎蛋白，计算甲胎蛋白的变化，即通过公式计算甲胎蛋白反应：AR=lgAFP/lgAFP（lg=log），分析患者生存与甲胎蛋白反应的关系，并探讨甲胎蛋白反应的潜在临床意义。结果在同一研究所的独立患者队列中得到验证。
共分析了 841 例符合条件的患者。我们确定甲胎蛋白反应的最佳临界值为 0.8135，并随后将探索队列中的患者分为甲胎蛋白反应者（甲胎蛋白反应≤0.8135；n=452）和甲胎蛋白无反应者（甲胎蛋白反应>0.8135；n=146）。多变量 Cox 分析显示，甲胎蛋白反应独立预测了术后的总生存（OS）和无复发生存（RFS）时间（均 P<.001）。在肿瘤复发风险较高的患者（单发肿瘤伴微血管侵犯或多发肿瘤）中，甲胎蛋白反应者的生存情况优于无反应者（P<.05）。这些结果通过倾向评分匹配人群和另一个独立队列得到验证。
对于术前甲胎蛋白阳性的肝癌患者，甲胎蛋白反应是一种可靠且简单的预测指标，可评估手术切除的肿瘤学效果，独立于肿瘤特征。
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