Yen Yi-Hao, Kee Kwong-Ming, Li Wei-Feng, Liu Yueh-Wei, Wang Chih-Chi, Hu Tsung-Hui, Tsai Ming-Chao, Lin Chih-Yun
Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan.
Cancers (Basel). 2023 Feb 15;15(4):1222. doi: 10.3390/cancers15041222.
A recent study from the US showed a decreasing trend in the elevated serum alpha-fetoprotein (AFP) level (i.e., ≥20 ng/mL) in hepatocellular carcinoma (HCC) patients at the time of diagnosis. Furthermore, advanced tumor stage and severe underlying liver disease were associated with elevated AFP levels. We aimed to evaluate this issue in an area endemic for hepatitis B virus (HBV). Between 2011 and 2020, 4031 patients were newly diagnosed with HCC at our institution. After excluding 54 patients with unknown AFP data, the remaining 3977 patients were enrolled in this study. Elevated AFP level was defined as ≥20 ng/mL. Overall, 51.2% of HCC patients had elevated AFP levels; this proportion remained stationary between 2011 and 2020 (51.8% vs. 51.1%). Multivariate analysis showed that female gender (odds ratio (OR) = 1.462; < 0.001), tumor size per 10 mm increase (OR = 1.155; < 0.001), multiple tumors (OR = 1.406; < 0.001), Barcelona Clinic Liver Cancer stages B-D (OR = 1.247; = 0.019), cirrhosis (OR = 1.288; = 0.02), total bilirubin > 1.4 mg/dL (OR = 1.218; = 0.030), and HBV- or hepatitis C virus (HCV)-positive status (OR = 1.720; < 0.001) were associated with elevated AFP levels. In conclusion, a stationary trend in elevated serum AFP level in HCC patients has been noted in the past 10 years. Advanced tumor stage, severe underlying liver disease, viral etiology, and female gender are associated with elevated AFP levels in HCC patients.
美国最近的一项研究显示，肝细胞癌（HCC）患者诊断时血清甲胎蛋白（AFP）水平升高（即≥20 ng/mL）呈下降趋势。此外，肿瘤晚期和严重的基础肝病与AFP水平升高有关。我们旨在评估乙型肝炎病毒（HBV）流行地区的这一问题。2011年至2020年期间，我院新诊断出4031例HCC患者。排除54例AFP数据不明的患者后，其余3977例患者纳入本研究。AFP水平升高定义为≥20 ng/mL。总体而言，51.2%的HCC患者AFP水平升高；这一比例在2011年至2020年期间保持稳定（51.8%对51.1%）。多因素分析显示，女性（比值比（OR）=1.462；<0.001）、肿瘤大小每增加10 mm（OR = 1.155；<0.001）、多发肿瘤（OR = 1.406；<0.001）、巴塞罗那临床肝癌分期B-D（OR = 1.247；= 0.019）、肝硬化（OR = 1.288；= 0.02）、总胆红素>1.4 mg/dL（OR = 1.218；= 0.030）以及HBV或丙型肝炎病毒（HCV）阳性状态（OR = 1.720；<0.001）与AFP水平升高有关。总之，过去10年中HCC患者血清AFP水平升高呈稳定趋势。肿瘤晚期、严重的基础肝病、病毒病因以及女性与HCC患者AFP水平升高有关。
