Czauderna Carolin, Schmidtmann Irene, Koch Sandra, Pilz Lukas, Heinrich Sophia, Otto Gerd, Mittler Jens, Lang Hauke, Kloeckner Roman, Düber Christoph, Sprinzl Martin F, Worns Marcus A, Galle Peter R, Marquardt Jens U, Weinmann Arndt
Department of Internal Medicine I, Johannes Gutenberg University, Mainz, Germany.
Department of Medicine I, University Medical Centre SchleswigHolstein-Campus Lübeck, Lübeck, Germany.
United European Gastroenterol J. 2021 Mar 11. doi: 10.1177/2050640620972611.
Hepatocellular carcinoma is one of the most lethal cancers worldwide. Novel prognostic and/or predictive biomarkers are urgently needed to improve patient management. Alpha-fetoprotein (AFP) is a well-established and widely used biomarker for hepatocellular carcinoma. However, diagnostic accuracy of static AFP values is limited and the clinical potential is a matter of ongoing scientific discussion.
We here evaluated the prognostic impact of pretreatment static and dynamic AFP variables on overall survival of hepatocellular carcinoma patients in a Western cohort.
Patients with confirmed hepatocellular carcinoma (n = 809) treated at the Johannes Gutenberg University Mainz between 1998 and 2014 and two available pretreatment AFP-values (AFP-slope) were retrospectively analysed. Clinicopathological baseline parameters, pretreatment static values and AFP-slope were assessed. Prognostic impact was determined by Kaplan-Meier analyses and Cox regression models.
High static and dynamic AFP variables prior to therapy were associated with reduced survival rates of hepatocellular carcinoma patients. Several known clinical parameters such as Child-Pugh B (p < 0.01) and C stage (p < 0.001), portal vein thrombosis (p < 0.001) and extrahepatic spread (p < 0.001) were confirmed as independent predictors for overall survival. Addition of static and/or dynamic AFP variable resulted in higher time-dependent area under the curves. Notably, in patients with more favourable prognosis, AFP-slope prior to therapy was a slightly stronger predictor for overall survival compared with static AFP values.
Static and dynamic AFP variables prior to therapy are predictive for overall survival of hepatocellular carcinoma patients. Addition of AFP-slope to established prognostic parameters might improve prognostic classification for a subgroup of hepatocellular carcinoma patients with preserved liver function and without portal vein tumour thrombosis.
肝细胞癌是全球致死率最高的癌症之一。迫切需要新的预后和/或预测生物标志物来改善患者管理。甲胎蛋白（AFP）是一种成熟且广泛应用于肝细胞癌的生物标志物。然而，静态AFP值的诊断准确性有限，其临床潜力仍是一个持续科学讨论的问题。
我们在此评估了西方队列中预处理静态和动态AFP变量对肝细胞癌患者总生存期的预后影响。
回顾性分析了1998年至2014年间在美因茨约翰内斯·古腾堡大学接受治疗且有两个可用预处理AFP值（AFP斜率）的确诊肝细胞癌患者（n = 809例）。评估了临床病理基线参数、预处理静态值和AFP斜率。通过Kaplan-Meier分析和Cox回归模型确定预后影响。
治疗前高静态和动态AFP变量与肝细胞癌患者生存率降低相关。几个已知的临床参数，如Child-Pugh B级（p < 0.01）和C期（p < 0.001）、门静脉血栓形成（p < 0.001）和肝外转移（p < 0.001）被确认为总生存期的独立预测因素。加入静态和/或动态AFP变量导致曲线下时间依赖性面积更高。值得注意的是，在预后较好的患者中，治疗前的AFP斜率比静态AFP值对总生存期的预测作用稍强。
治疗前的静态和动态AFP变量可预测肝细胞癌患者的总生存期。将AFP斜率加入既定的预后参数中可能会改善肝功能良好且无门静脉肿瘤血栓形成的肝细胞癌患者亚组的预后分类。
