Zakaria Hazem M, Mohamed Anwar, Omar Hazem, Gaballa Nahla K
Department of Hepatopancreatobiliary and Liver Transplant Surgery, National Liver Institute, Menoufia University, Egypt.
Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Egypt.
Ann Med Surg (Lond). 2020 May 4;54:109-113. doi: 10.1016/j.amsu.2020.04.014. eCollection 2020 Jun.
Total tumor volume (TTV) and serum alfa fetoprotein (AFP) level are important risk factors linked with the high possibility of hepatocellular carcinoma (HCC) recurrence. The aim of the study was to evaluate the role of AFP/TTV ratio, as a prognostic marker, in the prediction of HCC recurrence after resection.
Patients who underwent liver resection for HCC between 2010 and 2018 were retrospectively analyzed. Patients were divided into 2 groups; a group with AFP/TTV ≤2 and another group with AFP/TTV >2. Risk factors for HCC recurrence were recorded.
A total of 286 HCC patients underwent liver resection (184 patients with AFP/TTV ≤ 2, and 102 patients with AFP/TTV > 2). There was a significant difference between the 2 groups in the preoperative total bilirubin level, serum AFP level, mean tumor diameter, TTV, operative blood loss, microvascular invasion and hospital stay (all values < 0.05). The 1-, 3-, and 5-year tumor recurrence rates were 24.1%, 43%, and 57.6% respectively. The independent risk factors for tumor recurrence were AFP/TTV >2 (HR = 1.62, 95% CI = 1.29-1.98, = 0.042), Macrovascular invasion (HR = 2.03, 95% CI = 2.17-2.38, = 0.021, and microvascular invasion (HR = 1.36, 95% CI = 1.08-1.77, = 0.019).
AFP/TTV ratio is a feasible prognostic marker for prediction of HCC recurrence after resection so, it can help in providing an intensive postoperative surveillance program to high risk patients for early detection and management of any recurrence.
肿瘤总体积（TTV）和血清甲胎蛋白（AFP）水平是与肝细胞癌（HCC）高复发可能性相关的重要风险因素。本研究的目的是评估AFP/TTV比值作为一种预后标志物在预测肝癌切除术后复发中的作用。
回顾性分析2010年至2018年间因肝癌接受肝切除术的患者。患者分为两组；AFP/TTV≤2组和AFP/TTV>2组。记录肝癌复发的风险因素。
共有286例肝癌患者接受了肝切除术（184例AFP/TTV≤2，102例AFP/TTV>2）。两组在术前总胆红素水平、血清AFP水平、平均肿瘤直径、TTV、术中失血量、微血管侵犯和住院时间方面存在显著差异（所有值<0.05）。1年、3年和5年肿瘤复发率分别为24.1%、43%和57.6%。肿瘤复发的独立风险因素为AFP/TTV>2（HR=1.62，95%CI=1.29-1.98，P=0.042）、大血管侵犯（HR=2.03，95%CI=2.17-2.38，P=0.021）和微血管侵犯（HR=1.36，95%CI=1.08-1.77，P=0.019）。
AFP/TTV比值是预测肝癌切除术后复发的可行预后标志物，因此，它有助于为高危患者提供强化术后监测方案，以便早期发现和处理任何复发情况。
