Su Tung-Hung, Chang Shan-Han, Chen Chi-Ling, Liao Sih-Han, Tseng Tai-Chung, Hsu Shih-Jer, Hong Chun-Ming, Liu Chen-Hua, Yang Hung-Chih, Liu Chun-Jen, Chen Pei-Jer, Kao Jia-Horng
Department of Internal Medicine, Division of Gastroenterology and Hepatology, National Taiwan University Hospital, Taipei, Taiwan.
Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.
Hepatol Res. 2023 Oct;53(10):1021-1030. doi: 10.1111/hepr.13932. Epub 2023 Jun 23.
Alpha-fetoprotein (AFP) checkup with abdominal ultrasonography for hepatocellular carcinoma (HCC) surveillance remains controversial. We evaluated a serial AFP-increase and high AFP levels in the prediction of HCC.
At-risk patients with chronic liver disease underwent HCC surveillance with trimonthly AFP measurement were included and categorized into HCC and non-HCC groups. Their AFP levels at 12, 9, and 6 months (-6M) before the outcome date were evaluated. Group-based trajectory analysis and multivariable regression analysis were performed to identify AFP trajectories as risk predictors for HCC.
Overall, 2776 patients were included in the HCC (n = 326) and non-HCC (n = 2450) groups. Serial AFP levels were significantly higher in the HCC than the non-HCC groups. Trajectory analysis identified AFP-increase group (11%) increased 24-fold risks of HCC compared with the AFP-stable (89%) group. Compared with patients without the AFP-increase, a serial 3-month AFP-increase ≥10% elevated HCC risk by 12.1-fold (95% CI: 6.5-22.4) in 6 months, and the HCC risks increased 13-60 fold in patients with cirrhosis, hepatitis B, or C receiving antiviral therapy, or AFP levels <20 ng/ml. Combining serial AFP-increase ≥10% and AFP ≥20 ng/ml at -6M significantly increased 41.7-fold (95% CI: 13.8-126.2) HCC risks. In patients who underwent biannual AFP checkups, those with both 6-month AFP-increase ≥10% and AFP ≥20 ng/ml increased 22.1-fold (95% CI: 12.52-39.16) HCC risks in 6 months. Most HCCs were detected at an early stage.
Serial 3-6-month AFP-increase of ≥10% previously and AFP level of ≥20 ng/ml significantly increased HCC risks in 6 months.
采用甲胎蛋白（AFP）检查联合腹部超声进行肝细胞癌（HCC）监测仍存在争议。我们评估了连续AFP升高及AFP高水平在HCC预测中的作用。
纳入有慢性肝病的高危患者，每三个月测量一次AFP进行HCC监测，并分为HCC组和非HCC组。评估他们在结局日期前12个月、9个月和6个月（-6M）时的AFP水平。进行基于组的轨迹分析和多变量回归分析，以确定AFP轨迹作为HCC的风险预测指标。
总体上，HCC组（n = 326）和非HCC组（n = 2450）共纳入2776例患者。HCC组的连续AFP水平显著高于非HCC组。轨迹分析确定AFP升高组（11%）发生HCC的风险比AFP稳定组（89%）高24倍。与无AFP升高的患者相比，连续3个月AFP升高≥10%使6个月内HCC风险升高12.1倍（95%CI：6.5 - 22.4），在肝硬化、乙型或丙型肝炎接受抗病毒治疗或AFP水平<20 ng/ml的患者中，HCC风险升高13 - 60倍。在-6M时，连续AFP升高≥10%且AFP≥20 ng/ml显著使HCC风险升高41.7倍（95%CI：13.8 - 126.2）。在接受半年一次AFP检查的患者中，6个月时6个月AFP升高≥10%且AFP≥20 ng/ml的患者HCC风险升高22.1倍（95%CI：12.52 - 39.16）。大多数HCC在早期被检测到。
之前连续3 - 6个月AFP升高≥10%且AFP水平≥20 ng/ml显著增加6个月内HCC风险。
