血清AFP半衰期对早期预测HCC肝移植术后复发的临床价值

Value of serum α-fetoprotein half-life in early recurrence after liver transplantation for hepatocellular carcinoma

目的:通过研究肝细胞癌(hepatocellular carcinoma,HCC)患者肝移植术后的血清甲胎蛋白(α-fetoprotein,AFP)的动态变化及下降过程中半衰期(T1/2)的长短与肝癌术后复发的关系,探讨AFPT1/2对预测移植术后HCC复发的临床价值。方法:回顾性分析我院58例术前血清AFP阳性(AFP>25μg/L),且超过Milan标准的HCC患者,观察肝移植手术后的AFP动态变化并计算其下降过程的T1/2,研究AFPT1/2与移植术后肝癌复发的相关性,评估AFP的T1/2对预测HCC移植术后复发的价值。结果:移植术后复发组的血清AFPT1/2要明显高于未复发组(P<0.01)。当AFPT1/2<6.5d时,移植术后肿瘤复发转移的概率较小,远期预后较好。当AFPT1/2>6.5d时,复发转移的发生率要明显高于前者。根据患者移植术后的AFP的动态变化分为3组,A组(血清AFP1个月内降至<25μg/L)、B组(血清AFP于2个月内降至25μg/L以下)和C组(AFP于2个月内始终未降至25μg/Ll以下或是下降后再次回升),结果显示C组的复发率(85.7%)要明显高于A组(20%)和B组(33.3%),P均<0.05;A组和B组之间没有明显差异(P>0.05)。结论:移植术后血清AFP的动态变化与肿瘤的复发密切相关。血清AFP的T1/2对于早期预测HCC肝移植术后的复发有重要价值。

Objective： To evaluate serum α-fetoprotein （AFP） half-life and tumor recurrence after liver transplantation （LT） for hepatocellular carcinoma （HCC） patients. Metheds：Serum AFP alterations of 58 HCC patients whose serum AFP were positive （AFP 〉 25 μg/L） before transplantation were followed-up following liver transplantation. Patients were divided into three groups according to the postoperative time of serum AFP below 25 μg/L, group A （within 1 month ）,group B （within 2 months ） and group C （no decreasing or rising after decreasing）. Results：The average half-life time of serum AFP of recurrence group was obvious longer than that of the non-recurrence group （P〈0.01）. When the half-life of serum AFP was below 6.5 days, the recurrence rate was lower, and the prognosis was better. The recurrence rate in group C （85.7%） was higher than those in group A and group B （group C vs group A, P=0.009, group C vs group B, P=0.033）. The recurrence rate between group A and group B was not significantly different （P=0.230）. Conclusion： Serum AFP level had close correlation with tumor recurrence following liver transplantation in HCC patients.