甲胎蛋白模型预测肝癌根治性切除术后肿瘤复发。
Prediction of tumor recurrence by α-fetoprotein model after curative resection for hepatocellular carcinoma.
机构信息
Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner, Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
出版信息
Eur J Surg Oncol. 2021 Mar;47(3 Pt B):660-666. doi: 10.1016/j.ejso.2020.10.017. Epub 2020 Oct 15.
BACKGROUND
Preoperative α-fetoprotein (AFP) level levels may help select patients with hepatocellular carcinoma (HCC) for surgery. The objective of the current study was to assess an AFP model to predict tumor recurrence and patient survival after curative resection for HCC.
METHODS
Patients undergoing curative-intent resection for HCC between 2000 and 2017 were identified from a multi-institutional database. AFP score was calculated based on the last evaluation before surgery. Probabilities of tumor recurrence and overall survival (OS) were compared according to an AFP model.
RESULTS
A total of 825 patients were included. An optimal cut-off AFP score of 2 was identified with an AFP score ≥3 versus ≤2 independently predicting tumor recurrence and OS. Net reclassification improvements indicated the AFP model was superior to the Barcelona Clinic Liver Cancer (BCLC) system to predict recurrence (p < 0.001). Among patients with BCLC B-C, AFP score ≤2 identified a subgroup of patients with AFP levels of ≤100 ng/mL with a low 5-year recurrence risk (≤2 45.2% vs. ≥3 61.8%, p = 0.046) and favorable 5-year OS (≤2 54.5% vs. ≥3 39.4%, p = 0.035). In contrast, among patients within BCLC 0-A, AFP score ≥3 identified a subgroup of patients with AFP values > 1000 ng/mL with a high 5-year recurrence (≥3 47.9% vs. ≤2% 38.4%, p = 0.046) and worse 5-year OS (≥3 47.8% vs. ≤2 65.9%, p < 0.001). In addition, the AFP score independently correlated with vascular invasion, tumor differentiation and capsule invasion.
CONCLUSIONS
The AFP model was more accurate than the BCLC system to identify which HCC patients may benefit the most from surgical resection.
背景
术前甲胎蛋白（AFP）水平可能有助于选择肝细胞癌（HCC）患者进行手术。本研究的目的是评估一种 AFP 模型，以预测 HCC 根治性切除术后肿瘤复发和患者生存。
方法
从一个多机构数据库中确定了 2000 年至 2017 年期间接受 HCC 根治性切除术的患者。根据术前最后一次评估计算 AFP 评分。根据 AFP 模型比较肿瘤复发和总生存（OS）的概率。
结果
共纳入 825 例患者。确定了最佳 AFP 评分截断值为 2，AFP 评分≥3 与≤2 独立预测肿瘤复发和 OS。净重新分类改善表明 AFP 模型优于巴塞罗那临床肝癌（BCLC）系统来预测复发（p<0.001）。在 BCLC B-C 患者中，AFP 评分≤2 确定了一组 AFP 水平≤100ng/mL 的患者，其 5 年复发风险较低（≤2 为 45.2%，≥3 为 61.8%，p=0.046）和良好的 5 年 OS（≤2 为 54.5%，≥3 为 39.4%，p=0.035）。相比之下，在 BCLC 0-A 患者中，AFP 评分≥3 确定了一组 AFP 值>1000ng/mL 的患者，其 5 年复发率较高（≥3 为 47.9%，≤2 为 38.4%，p=0.046）和较差的 5 年 OS（≥3 为 47.8%，≤2 为 65.9%，p<0.001）。此外，AFP 评分与血管侵犯、肿瘤分化和包膜侵犯独立相关。
结论
AFP 模型比 BCLC 系统更准确地识别出哪些 HCC 患者可能从手术切除中获益最大。
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