目标:根据巴塞罗那诊所肝癌(BCLC)算法,肿瘤负荷和肝功能,但不是肿瘤生物学,是决定肿瘤分期和治疗方式的关键因素,并评估治疗预后。血清甲胎蛋白(AFP)水平是肝细胞癌(HCC)生物学的重要特征,我们旨在评估其对早期HCC肝切除术患者的预后价值。
方法:从多机构数据库中确定了接受早期HCC治愈性肝切除术的患者。根据术前AFP水平将患者分为三组:低(<400ng/mL),高(400-999ng/mL),和极高(≥1000ng/mL)AFP组。比较三组的总生存率(OS)和复发率。
结果:在1284名患者中,720(56.1%),262(20.4%),302例(23.5%)患者术前低,高,和极高的AFP水平,分别。低AFP组患者5年累计OS和复发率分别为71.3%和38.9%,高AFP组66.3%和48.5%,在极高AFP组中分别为45.7%和67.2%,分别(均p<0.001)。多因素Cox回归分析确定了高和极高的AFP水平是OS的独立危险因素(风险比[HR]1.275和1.978,95%置信区间[CI]分别为1.004-1.620和1.588-2.464;p=0.047和p<0.001)和复发(分别为HR1.290和2.050,95%CI1.047-1.588和1.692-2.484;p<
结论:本研究表明,在早期肝癌切除术患者中,术前AFP水平具有重要的预后价值。将AFP纳入BCLC算法的预后评估可以帮助指导个性化风险分层并确定新辅助/辅助治疗的必要性。
OBJECTIVE: According to the Barcelona Clinic Liver Cancer (BCLC) algorithm, tumor burden and liver function, but not tumor biology, are the key factors in determining tumor staging and treatment modality, and evaluating treatment prognosis. The serum α-fetoprotein (AFP) level is an important characteristic of hepatocellular carcinoma (HCC) biology, and we aimed to evaluate its prognostic value for patients undergoing liver resection of early-stage HCC.
METHODS: Patients who underwent curative liver resection for early-stage HCC were identified from a multi-institutional database. Patients were divided into three groups according to preoperative AFP levels: low (< 400 ng/mL), high (400-999 ng/mL), and extremely-high (≥ 1000 ng/mL) AFP groups. Overall survival (OS) and recurrence rates were compared among these three groups.
RESULTS: Among 1284 patients, 720 (56.1%), 262 (20.4%), and 302 (23.5%) patients had preoperative low, high, and extremely-high AFP levels, respectively. The cumulative 5-year OS and recurrence rates were 71.3 and 38.9% among patients in the low AFP group, 66.3 and 48.5% in the high AFP group, and 45.7 and 67.2% in the extremely-high AFP group, respectively (both p < 0.001). Multivariate Cox regression analysis identified both high and extremely-high AFP levels to be independent risk factors of OS (hazard ratio [HR] 1.275 and 1.978, 95% confidence interval [CI] 1.004-1.620 and 1.588-2.464, respectively; p = 0.047 and p < 0.001, respectively) and recurrence (HR 1.290 and 2.050, 95% CI 1.047-1.588 and 1.692-2.484, respectively; p = 0.017 and p < 0.001, respectively).
CONCLUSIONS: This study demonstrated the important prognostic value of preoperative AFP levels among patients undergoing resection for early-stage HCC. Incorporating AFP to prognostic estimation of the BCLC algorithm can help guide individualized risk stratification and identify neoadjuvant/adjuvant treatment necessity.