外科理论与实践2012，Vol.17Issue(6)：668-672,5.DOI:10.3969/j.issn.1007-9610.2012.06.018
复发时甲胎蛋白的不同水平对肝癌预后的影响
Prognosis of recurrent hepatocellular carcinoma with different α-fetoprotein levels when recurring
刘光华 1刘学 1乔国梁 1樊啸 1万旭英 1夏勇 1沈锋1
作者信息
- 1. 第二军医大学东方肝胆外科医院肝外四科,上海200438
- 折叠
摘要
Abstract
Objective To identify the clinical outcomes of patients with recurrent hepatocellular carcinoma (HCC) with different a-fetoprotein (AFP) levels when recurring. Methods 821 patients with recurrent HCC who initially underwent curative hepatectomy from Eastern Hepatobiliary Surgery Hospital were studied retrospectively. There were 3 groups according to AFP levels when recurring: group A (negative group), AFP≤20 ng/mL (n=4]2); group B(mildly elevated group), AFP 21-400 ng/mL (n=264); and group C (highly elevated group), AFP>400 ng/mL (n=145). The clinical characteristics, recurrence-to-death survival rates, and other risk factors influencing prognosis were compared. Results Compared to those in group A and B, group C tended to present more without / incomplete primary tumor capsule (P< 0.001),more microvascular invasion (P<0.001), poorer tumor differentiation (P<0.001), greater recurrent tumor diameter (P-0.001) as well as shorter time-to-recurrence (P<0.001). Univariate analysis revealed that primary tumor diameter, blood transfusion, tumor capsule, microvascular invasion, recurrent tumor diameter, recurrent tumor number, time-to-recurrence interval, treatment modalities at recurrence, and recurrent AFP level were the factors to affect on recurrence-to-death survival rates (P<0.05). With COX model multivariate analysis, primary tumor diameter >5 cm, recurrent tumor diameter >3 cm, recurrent tumor number≥2, high recurrent AFP level, and non-surgical treatment at recurrence were the risk factors of recurrence-to-death survival rates. The hazard ratio (HE) for recurrence-to-death survival in group B compared with that of group A was 1.46 (95%CI:1.06-2.01 ,P=0.021). The HR for recurrence-to-death survival in group C compared with that of group A was 2.77 (95%CI:1.89-4.05 ,P<0.001). Conclusions Recurrent AFP level correlated with clinicopathologic characteristics of tumor invasive. The higher AFP level at recurrent, the poorer the recurrence-to-death survival is. AFP is considered as an important prognostic indicator for patients with recurrent HCC who initially underwent curative hepatectomy.关键词
肝癌/甲胎蛋白/复发后生存率Key words
Hepatocellular carcinoma/ a-fetoprotein / Recurrence-to-death survival rates分类
医药卫生引用本文复制引用
刘光华,刘学,乔国梁,樊啸,万旭英,夏勇,沈锋..复发时甲胎蛋白的不同水平对肝癌预后的影响[J].外科理论与实践,2012,17(6):668-672,5.
