Shimada M, Takenaka K, Fujiwara Y, Gion T, Kajiyama K, Maeda T, Shirabe K, Sugimachi K
Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Cancer. 1996 Nov 15;78(10):2094-100. doi: 10.1002/(sici)1097-0142(19961115)78:10<2094::aid-cncr9>3.0.co;2-o.
The aim of this study was to elucidate the usefulness of measuring the positive status of both des-gamma-carboxy prothrombin (DCP) and alpha-fetoprotein (AFP) preoperatively as a new prognostic indicator of hepatocellular carcinoma (HCC).
One hundred forty-seven patients who underwent curative hepatic resection for primary HCC were studied. The definitions of DCP and AFP positivity were: positive DCP > 0.1 AU/ml, and positive AFP > 50 ng/ml. The patients were classified into four groups according to their levels of positivity for DCP and/or AFP: Group 1 (n = 59), negative levels of both DCP and AFP; Group 2 (n = 28), negative DCP and positive AFP levels; Group 3 (n = 31), positive DCP and negative AFP levels; and Group 4 (n = 29), positive levels of both DCP and AFP.
Patient survival and disease free survival in Group 4 were the worst among the four groups. By multivariate analysis, using Cox proportional hazards model, both the DCP- and AFP-positive status (in combination) and poorly differentiated histology were independent factors of poor prognosis for patient survival; and DCP- and AFP-positive status (in combination), poorly differentiated histology, positive intrahepatic metastasis, and tumor diameter over 5 cm were independent factors of poor prognosis for disease free survival.
The combination of DCP- and AFP-positive status is a new prognostic indicator for patients with HCC after hepatic resection.
本研究的目的是阐明术前检测去γ-羧基凝血酶原（DCP）和甲胎蛋白（AFP）阳性状态作为肝细胞癌（HCC）新的预后指标的实用性。
对147例行原发性HCC根治性肝切除术的患者进行研究。DCP和AFP阳性的定义为：DCP阳性>0.1 AU/ml，AFP阳性>50 ng/ml。根据患者DCP和/或AFP的阳性水平将其分为四组：第1组（n = 59），DCP和AFP均为阴性；第2组（n = 28），DCP阴性且AFP阳性；第3组（n = 31），DCP阳性且AFP阴性；第4组（n = 29），DCP和AFP均为阳性。
第4组患者的生存率和无病生存率在四组中最差。通过多因素分析，采用Cox比例风险模型，DCP和AFP阳性状态（联合）以及低分化组织学是患者生存预后不良的独立因素；DCP和AFP阳性状态（联合）、低分化组织学、肝内转移阳性以及肿瘤直径超过5 cm是无病生存预后不良的独立因素。
DCP和AFP阳性状态的联合是肝切除术后HCC患者新的预后指标。
