血清AFP阴性的肝细胞癌患者预后及分期系统分析

叶颖剑; 刘波; 陈伟; 李琼霞

doi:10.3969/j.issn.1001-5256.2019.03.017

血清AFP阴性的肝细胞癌患者预后及分期系统分析

DOI: 10.3969/j.issn.1001-5256.2019.03.017

湖北医药学院附属襄阳市第一人民医院消化科

基金项目:

湖北省自然科学基金(2018CFB619)；

详细信息

中图分类号: R735.7
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出版历程
- 收稿日期: 2018-10-10
- 出版日期: 2019-03-20

Prognosis and staging system analysis of hepatocellular carcinoma patients with negative serum alpha-fetoprotein

Department of Gastroenterology, Xiangyang First People's Hospital Affiliated to Hubei Medical College

Research funding:

摘要

摘要: 目的初步分析血清AFP阴性（<20 ng/ml）肝细胞癌患者的预后及分期系统,并确定影响AFP阴性患者术后生存率的危险因素及临床疗效评价的最佳评分系统。方法回顾性分析2012年1月-2017年12月在湖北医药学院附属襄阳市第一人民医院行手术切除的188例肝细胞癌患者的临床资料,其中AFP阳性组127例,AFP阴性组61例。比较两组的肿瘤相关因素、手术相关因素和其他临床资料。符合正态分布的计量资料2组间比较采用t检验;非正态分布的计量资料2组间比较采用Mann-Whit-ney U检验。计数资料2组间比较采用χ2检验。总体生存率和无复发生存率用Kaplane-Meier生存曲线计算,两组的生存差异用log-rank检验,采用Cox比例风险模型进行单因素和多因素分析确定影响AFP阴性组生存率的危险因素,及TNM系统、巴塞罗那临床肝癌评分系统（BCLC）、意大利肝脏肿瘤评分（CLIP）、国内分期（CS）、日本整体分期评分系统（JIS）和Okuda分期对于AFP阴性组术后生存情况的判断力。结果肝癌患者中AFP阴性者占32. 45%（61/188）,相对于AFP阳性患者,阴性组患者趋向于有...
- 癌,肝细胞 /
- 甲胎蛋白类 /
- 肿瘤分期 /
- 预后
Abstract: Objective To investigate the effect of negative expression of serum alpha-fetoprotein ( AFP) ( < 20 ng/L) on the prognosisand staging of patients with hepatocellular carcinoma ( HCC) , the risk factors for postoperative survival rate of AFP-negative patients, andthe best scoring system for clinical outcome evaluation. Methods A retrospective analysis was performed for the clinical data of 188 patientswith HCC who underwent surgical resection in Xiangyang First People's Hospital Affiliated to Hubei Medical College from January 2012 toDecember 2017, among whom 127 had positive AFP ( AFP-positive group) and 61 had negative AFP ( AFP-negative group) . The twogroups were compared in terms of tumor-related factors, surgery-related factors, and other clinical data. The t-test was used for compari-son of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally dis-tributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. The Kaplan-Meier survival curve was used to calculate overall survival rate and relapse-free survival rate, and the log-rank test was used for compari-son of survival between two groups. The Cox proportional hazards model was used for univariate and multivariate analyses to identify the riskfactors for survival rate in the AFP-negative group and to evaluate the value of TNM system, Barcelona Clinic Liver Cancer ( BCLC) sys-tem, Cancer of the Liver Italian Program ( CLIP) score, Chinese staging ( CS) system, Japan Integrated Staging ( JIS) score, and Okudastaging system in judging postoperative survival of the AFP-negative group. Results Of all 188 HCC patients, 61 ( 32. 45%) had negative AFP. Moreover, compared with the AFP-positive patients, the AFP-negative patients tended to have a more complete capsule ( χ2=7. 234, P = 0. 007) , a better pathological stage ( χ2= 6. 698, P = 0. 01) , a higher survival rate ( χ2= 9. 580, P = 0. 002) , and a lower recurrence rate ( χ2= 8. 407, P = 0. 004) . Child-Pugh class B HCC ( hazard ratio [HR]= 1. 711, 95% confidence interval [CI]: 1. 073 ～39. 921, P = 0. 001) , a high level of bilirubin ( HR = 1. 044, 95% CI: 1. 006-1. 083, P = 0. 021) , and absence of tumor capsule ( HR =7. 025, 95% CI: 1. 319-37. 401, P = 0. 022) were independent risk factors for a reduced overall survival rate in the AFP-negative group.Tumor diameter > 3 cm ( HR = 4. 172, 95% CI: 1. 271-13. 691, P = 0. 019) , absence of tumor capsule ( HR = 8. 901, 95% CI: 2. 352-33. 693, P = 0. 001) , and vascular invasion ( HR = 0. 043, 95% CI: 0. 003-0. 584, P = 0. 018) were risk factors for an increased recurrence rate of tumor in the AFP-negative group. The univariate analysis showed that among these six staging systems, the TNM and BCLC staging systems were significantly associated with overall survival rate and relapse-free survival rate ( P < 0. 05) and the CS system was only significantly associated with overall survival rate ( P < 0. 05) ; the multivariate analysis showed that only the BCLC stating system was significantly associated with overall survival rate ( HR = 0. 124, 95% CI: 0. 038-0. 401, P < 0. 01) and that the TNM staging system ( HR =0. 339, 95% CI: 0. 158-0. 952, P = 0. 039) and the BCLC staging system ( HR = 0. 177, 95% CI: 0. 058-0. 539, P = 0. 002) were significantly associated with relapse-free survival rate. Conclusion AFP-negative patients often have good liver reserve function and biological behavior and high survival rate and relapse-free survival rate. Among the above six staging systems, only the BCLC staging system is significantly associated with both overall survival rate and relapse-free survival rate after surgery, and therefore, it is the best system for evaluating postoperative survival and prognosis in AFP-negative patients.
- carcinoma, hepatocellular /
- alpha-fetoproteins /
- neoplasm staging /
- prognosis

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