背景 甲胎蛋白作为一种肿瘤标志物，已经用于肝硬化后对肝细胞癌的监视及诊断，但它对肝细胞癌患者的预后能力还尚不明确。目的 此项研究旨在评估血清中甲胎蛋白对一组特定肝硬化患者的预后效能。这些患者代偿良好，具有最佳的体力状态，在定期超声监察过程中检查出了小细胞癌，并进行了以根治性为目的的治疗。患者和方法 从意大利肝癌研究组数据库收录的3,027位患者中，选取了205位患者。这些患者满足以下条件：肝硬化、Child-Pugh评分为A、ECOG（美国东部肿瘤协作组）体力状态评分为0、在监视肝硬化过程中检查出直径不大于3厘米的单个肝细胞癌，并且进行了以根治性为目的的治疗（肝切除、肝移植、经皮无水乙醇注射和射频消融术）。根据血清中甲胎蛋白水平将患者分为3组（即≤ 20 ng/mL为正常组； 21-200 ng/mL 为轻度升高组； >200 ng/mL 为显著升高组）。结果 通过Kaplan-Meier生存分析，发现3组患者的生存时间没有显著差别（ P = 0.493 ）。对肿瘤直径小于等于2厘米的患者进行分析得到了相同的结果（ P = 0.714 ）。为观察血清甲胎蛋白对生存和死亡患者的区分能力，构造受试者操作特征曲线，识别出100 ng/mL 为最佳区分阈值，但该阈值的准确度不足（曲线下面积为0.536，95%置信区间为0.465-0.606 ）。结论 血清中甲胎蛋白水平对代偿良好，仅具有单个小肝细胞癌并经过根治性治疗的肝硬化患者无预后意义。
吉林大学第一医院肝胆胰内科 吴瑞红 摘译
本文首次发表于[Hepatology, 2012, oct ]
Alpha-Fetoprotein Has No Prognostic Role in Small Hepatocellular Carcinoma Identified During Surveillance in Compensated Cirrhosis
Backgrounds Alpha-fetoprotein is a tumor marker that has been used for surveillance and diagnosis of hepatocellular carcinoma (HCC) in patients with cirrhosis. The prognostic capability of this marker in patients with HCC has not been clearly defined. Aims In this study our aim was to evaluate the prognostic usefulness of serum alpha-fetoprotein in patients with well-compensated cirrhosis, optimal performance status, and small HCC identified during periodic surveillance ultrasound who were treated with curative intent. Patients and Methods Among the 3,027 patients included in the Italian Liver Cancer study group database, we selected 205 Child-Pugh class A and Eastern Cooperative Group Performance Status 0 patients with cirrhosis with a single HCC≤ 3 cm of diameter diagnosed during surveillance who were treated with curative intent (hepatic resection, liver transplantation, percutaneous ethanol injection, radiofrequency thermal ablation). Patients were subdivided according to alpha-fetoprotein serum levels (i.e., normal ≤ 20 ng/mL; mildly elevated 21-200 ng/mL; markedly elevated >200 ng/mL). Results Patient survival, as assessed by the Kaplan-Meier method, was not significantly different among the three alpha-fetoprotein classes (P = 0.493). The same result was obtained in the subgroup of patients with a single HCC ≤ 2 cm (P = 0.714). An alpha-fetoprotein serum level of 100 ng/mL identified by receiver operating characteristic curve had inadequate accuracy (area under the curve =0.536, 95% confidence interval =0.465-0.606) to discriminate between survivors and deceased patients. Conclusion Alpha-fetoprotein serum levels have no prognostic meaning in well-compensated cirrhosis patients with single, small HCC treated with curative intent.
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