Becker-Assmann Jendrik, Fard-Aghaie Mohammad H, Kantas Alexandros, Makridis Georgios, Reese Tim, Wagner Kim C, Petersen Jörg, Buggisch Peter, Stang Axel, von Hahn Thomas, Oldhafer Karl J
Department für Chirurgie, Klinik für Leber‑, Gallenwegs- und Pankreaschirurgie, Asklepios Klinik Barmbek, Rübenkamp 220, 22373, Hamburg, Deutschland.
Campus Hamburg, Semmelweis Universität Budapest, Hamburg, Deutschland.
Chirurg. 2020 Sep;91(9):769-777. doi: 10.1007/s00104-020-01118-6.
Hepatocellular carcinoma (HCC) is an aggressive tumor with a growing socioeconomic burden. International guidelines do not predominantly recommend the pretherapeutic determination of the alpha-fetoprotein (AFP) concentration. Regarding the prognostic value of AFP, the European study data are not sufficiently meaningful.
This study aimed to demonstrate possible aspects of the AFP level and to investigate the prognostic value of AFP levels as well as to provide impetus for future prospective studies.
At the time of data retrieval the prospective liver databank showed 1382 entries. All patients with a histologically confirmed HCC were included resulting in 92 final entries. For these patients, information on T, N, M and G stages, R status as well as sex, age and etiology of the HCC were available. For data analysis the patient population was divided into six groups based on three cut-off values. Furthermore, a survival analysis was performed using Kaplan-Meier and a multifactorial analysis of the influencing factors regarding outcome.
The AFP serum level showed a statistically significant correlation with the tumor diameter (T1/T2 vs. T3/T4) and grading (G1/G2 vs. G3/G4). The survival prognosis was significantly lower in patients with higher AFP values (p < 0.05). The median survival time for patients with AFP levels >8 μg/l was 35 months, with AFP levels >200 μg/l or >400 μg/l showed a reduced median survival of 15 months and 11 months, respectively. High AFP levels were a significant influencing factor for the outcome independent of the T stage, age and R status of patients in comparison to low AFP levels.
Taking the present results into consideration, the AFP level can have a therapeutic usefulness. Therapeutic consequences could be derived from the height of the measured AFP concentration, with respect to the treatment strategy. Therefore, preoperative and postoperative determination of the AFP serum level is recommended in all HCC patients.
肝细胞癌（HCC）是一种侵袭性肿瘤，其社会经济负担日益加重。国际指南并未主要推荐治疗前测定甲胎蛋白（AFP）浓度。关于AFP的预后价值，欧洲的研究数据意义不足。
本研究旨在阐明AFP水平的可能情况，调查AFP水平的预后价值，并为未来的前瞻性研究提供动力。
在数据检索时，前瞻性肝脏数据库显示有1382条记录。所有经组织学确诊为HCC的患者均被纳入，最终有92条记录。对于这些患者，可获取关于T、N、M和G分期、R状态以及HCC的性别、年龄和病因的信息。为进行数据分析，根据三个临界值将患者群体分为六组。此外，使用Kaplan-Meier进行生存分析，并对影响预后的因素进行多因素分析。
AFP血清水平与肿瘤直径（T1/T2与T3/T4）和分级（G1/G2与G3/G4）具有统计学显著相关性。AFP值较高的患者生存预后明显较低（p<0.05）。AFP水平>8μg/L的患者中位生存时间为35个月，AFP水平>200μg/L或>400μg/L的患者中位生存时间分别降至15个月和11个月。与低AFP水平相比，高AFP水平是影响患者预后的一个重要因素，与患者的T分期、年龄和R状态无关。
考虑到目前的结果，AFP水平可能具有治疗用途。可根据测得的AFP浓度高低得出治疗结果，这与治疗策略有关。因此，建议对所有HCC患者进行术前和术后AFP血清水平测定。
