肝细胞癌患者临床病理特征、预后因素及生存结局与基线甲胎蛋白水平的相关性：一种虽受损但未失效的生物标志物
Correlation of Clinicopathological Profile, Prognostic Factors, and Survival Outcomes with Baseline Alfa-Fetoprotein Levels in Patients With Hepatocellular Carcinoma: A Biomarker that is Bruised but Not Broken.
作者信息
Jearth Vaneet, Patil Prachi S, Mehta Shaesta, Sundaram Sridhar, Seth Vishal, Goel Mahesh, Patkar Shraddha, Bal Munita, Rao Vidya
机构信息
Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India.
Division of Hepatobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
出版信息
J Clin Exp Hepatol. 2022 May-Jun;12(3):841-852. doi: 10.1016/j.jceh.2021.11.006. Epub 2021 Nov 16.
BACKGROUND AND AIMS
The role of Alfa-fetoprotein (AFP) in the management of hepatocellular carcinoma (HCC) is still debated, with differences in recommendations between international guidelines. We analyzed the relationship of the clinicopathological profile, prognostic features, and survival outcomes with baseline serum AFP levels in patients with HCC.
METHODS
Retrospective analysis of a prospectively accrued dataset of consecutive HCC patients was done.
RESULTS
508 treatment naive patients were included in the analysis. AFP at presentation was normal (<10 ng/ml) in 18% patients. Patients with very high AFP (>400 ng/ml) had poor hepatic reserves (higher mean serum bilirubin, AST, ALT, INR, and lower mean albumin) and advanced disease at presentation (higher incidence of extrahepatic metastasis, and less proportion of patients with well-differentiated tumors). AFP >400 ng/ml was an independent predictor for presence of portal vein tumor thrombosis (PVTT) (OR, 4.08; 95% CI, 2.34-7.12; < 0.001), higher tumor size (OR, 2.19; 95% CI, 1.36-3.54, = 0.001) and advanced BCLC stage (OR, 4.19; 95% CI, 2.51-7.03; < 0.001). Two-third of patients with small HCC (MTD <3 cm) and more than half with early-stage HCC (BCLC stage 0/A) had elevated AFP levels. No significant relationship was seen between overall survival (OS) and baseline AFP in patients who underwent surgery, but median OS in patients subjected to nonsurgical therapies was 19.4,10.5 and 5.7 months in patients having AFP <10 ng/ml, 10-400 ng/ml and >400 ng/ml respectively ( = 0.003). AFP >400 ng/ml was an independent predictor of survival in patients receiving any form of therapy (HR = 2.23; 95% CI = 1.19-4.18, = 0.012).
CONCLUSION
AFP as a biomarker still has a significant role to play in the management of HCC patients and is here to stay till the search for an ideal biomarker in HCC is over.
背景与目的
甲胎蛋白（AFP）在肝细胞癌（HCC）管理中的作用仍存在争议，国际指南之间的推荐存在差异。我们分析了HCC患者的临床病理特征、预后特征及生存结局与基线血清AFP水平之间的关系。
方法
对前瞻性收集的连续HCC患者数据集进行回顾性分析。
结果
508例未经治疗的患者纳入分析。初诊时AFP正常（<10 ng/ml）的患者占18%。AFP水平极高（>400 ng/ml）的患者肝脏储备功能较差（平均血清胆红素、AST、ALT、INR较高，平均白蛋白较低），初诊时疾病分期较晚（肝外转移发生率较高，高分化肿瘤患者比例较低）。AFP>400 ng/ml是门静脉癌栓（PVTT）存在（OR，4.08；95%CI，2.34 - 7.12；P<0.001）、肿瘤较大（OR，2.19；95%CI，1.36 - 3.54，P = 0.001）及BCLC分期较晚（OR，4.19；95%CI，2.51 - 7.03；P<0.001）的独立预测因素。三分之二的小肝癌（MTD<3 cm）患者及半数以上的早期HCC（BCLC 0/A期）患者AFP水平升高。接受手术治疗的患者总生存期（OS）与基线AFP之间无显著关系，但接受非手术治疗的患者中，AFP<10 ng/ml、10 - 400 ng/ml及>400 ng/ml的患者中位OS分别为19.4、10.5及5.7个月（P = 0.003）。AFP>400 ng/ml是接受任何形式治疗患者生存的独立预测因素（HR = 2.23；95%CI = 1.19 - 4.18，P = 0.012）。
结论
AFP作为一种生物标志物在HCC患者管理中仍具有重要作用，并且在找到HCC理想生物标志物之前仍将继续发挥作用。
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