Wang Qi, Liu Biyu, Qiao Wenying, Li Jianjun, Yuan Chunwang, Long Jiang, Hu Caixia, Zang Chaoran, Zheng Jiasheng, Zhang Yonghong
Research Center for Biomedical Resources, Beijing You'an Hospital, Capital Medical University, Beijing, China.
Interventional Therapy Center for Oncology, Beijing You'an Hospital, Capital Medical University, Beijing, China.
Front Oncol. 2021 Dec 16;11:756363. doi: 10.3389/fonc.2021.756363. eCollection 2021.
Although many studies have confirmed the prognostic value of preoperative alpha-fetoprotein (AFP) in patients with hepatocellular carcinoma (HCC), the association between AFP at baseline (b-AFP), subsequent AFP at relapse (r-AFP), and AFP alteration and overall survival in HCC patients receiving locoregional therapy has rarely been systematically elucidated.
A total of 583 subjects with newly diagnosis of virus-related HCC who were admitted to Beijing You 'an Hospital, Capital Medical University from January 1, 2012 to December 31, 2016 were prospectively enrolled. The influence of b-AFP, subsequent r-AFP, and AFP alteration on relapse and post-recurrence survival were analyzed.
By the end of follow-up, a total of 431 (73.9%) patients relapsed and 200 (34.3%) died. Patients with positive b-AFP had a 24% increased risk of recurrence compared with those who were negative. Patients with positive r-AFP had a 68% increased risk of death after relapse compared with those who were negative. The cumulative recurrence-death survival (RDS) rates for 1, 3, 5 years in patients with negative r-AFP were 85.6% (184/215), 70.2%(151/215), and 67.4%(145/215), while the corresponding rates were 75.1% (154/205), 51.2% (105/205), and 48.8% (100/205) in those with positive AFP (P<0.001). 35 (21.6%) of the 162 patients with negative b-AFP turned positive at the time of recurrence, and of this subset, only 12 (34.3%) survived. Of the 255 patients with positive b-AFP, 86 (33.7%) turned negative at the time of relapse, and of this subset, only 30 (34.9%) died. The 1-, 3-, and 5-year cumulative RDS rates were also compared among groups stratified by AFP at baseline and relapse. The present study found that patients with positive AFP at baseline and relapse, as well as those who were negative turned positive, had the shortest RDS and OS.
Not only AFP at baseline but also subsequent AFP at relapse can be used to predict a post-recurrence survival, which can help evaluate mortality risk stratification of patients after relapse.
尽管许多研究已证实术前甲胎蛋白（AFP）对肝细胞癌（HCC）患者的预后价值，但基线AFP（b-AFP）、复发时的后续AFP（r-AFP）以及AFP变化与接受局部区域治疗的HCC患者总生存期之间的关联，很少得到系统阐述。
前瞻性纳入了2012年1月1日至2016年12月31日期间入住首都医科大学附属北京佑安医院的583例新诊断为病毒相关性HCC的患者。分析了b-AFP、后续r-AFP以及AFP变化对复发和复发后生存期的影响。
随访结束时，共有431例（73.9%）患者复发，200例（34.3%）患者死亡。b-AFP阳性患者的复发风险比阴性患者高24%。r-AFP阳性患者复发后的死亡风险比阴性患者高68%。r-AFP阴性患者1年、3年、5年的累积复发-死亡生存期（RDS）率分别为85.6%（184/215）、70.2%（151/215）和67.4%（145/215），而AFP阳性患者的相应比率分别为75.1%（154/205）、51.2%（105/205）和48.8%（100/205）（P<0.001）。162例b-AFP阴性患者中有35例（21.6%）在复发时转为阳性，在这一子集中，只有12例（34.3%）存活。255例b-AFP阳性患者中，86例（33.7%）在复发时转为阴性，在这一子集中只有30例（34.9%）死亡。还比较了按基线和复发时AFP分层的各组之间的1年、3年和5年累积RDS率。本研究发现，基线和复发时AFP均为阳性以及由阴性转为阳性的患者，其RDS和总生存期最短。
不仅基线AFP，而且复发时的后续AFP均可用于预测复发后的生存期，这有助于评估患者复发后的死亡风险分层。
