AFP和DCP在肝癌患者预后评价中的作用

Function of AFP and DCP in evaluating the prognosis of hepatocarcinoma

目的通过检测肝癌患者术后甲胎蛋白（AFP）和γ-羧基凝血酶原（DCP）水平的变化情况，评估AFP和DCP在肝癌患者预后评价中的作用。方法回顾性分析105例接受根治性切除的肝癌患者术前及术后AFP和DCP水平，并根据两指标变化情况将患者分为3组：治疗前后在正常参考值范围内（N组）；治疗前水平高于正常参考值上限，但治疗后回降至正常范围内（D组）；治疗前水平正常，但治疗后高于正常参考值上限及治疗前水平高于正常参考值上限，治疗后虽有下降但仍高于正常参考值上限，或治疗前后无改变，或治疗后水平升高（P组）。再联合两种指标，将患者分为术后两指标均阴性组（A组）、AFP阳性而DCP阴性组（B组）、AFP阴性而DCP阳性组（C组）和两指标均阳性组（D组）。分析两指标与患者预后的关系。结果高水平AFP和DCP与患者总体生存率和无瘤生存率密切相关。AFP—N组的3年、5年无瘤生存率（66．7％、42．8％）比D组（37．8％、27．2％）和P组（27．8％、16．1％）高；N组3年、5年总体生存率（80．1％、66．7％）高于D组（51．4％、29．7％）和P组（36．1％、19．4％）。DCP—N组的3年、5年总体生存率（77．8％、50．0％）高于P组（32．5％、22．5％）。联合分析两指标，A组3年、5年总体生存率（58．8％、47．1％）和无瘤生存率（47．1％、38．2％）明显高于其他各组，而D组（25％、0；25％、6．2％）则低于其他各组；B组和C组间生存率差异不明显。结论AFP和DCP均可独立作为肿瘤预后评价的标志分子且预后和指标阳性程度相关。联合进行两项指标检测，可以更好分析患者预后情况。

Objective To evaluate the prognosis in patients with hepatocarcinoma by examining the expression of α-fetoprotein （AFP） and des γ prothrombin （DCP）. Methods Retrospectively analyzed the expression of AFP and DCP in 105 patients received curative hepatectomy. Divided the patients into three groups as follow： the tumor markers were both negative pre-and post-operation （ Group N） ; the tumor markers decreased to normal after opera- tion （Group D） ; the tumor markers kept positive or decreased but still higher positive after operation （Group P）. Then combined the two markers and divided the patients into 4 groups： two markers both negative（ AFP ＋ DCP ＋ ） （ Group A） ; AFP ＋ DCP- （ Group B） ; AFP- DCP ＋ （ Group C） ; AFP- DCP- （ Group D）. Results High AFP and DCP levels were significantly associated with poor tumor-free and overall survival. The presence of large size and advanced stage were significantly associated with Group P. Overall survival in the AFP-N group was significantly better than that of other groups and overall survival in DCP-N group were significantly better than that of the P group. After the combination, Group A had the best overall and tumor free survival rate while the D group had the worst. The differences between B and C group were not significant. Conclusions AFP and DCP can be both used solely as tumor markers and the expressions of them are associated with the prognosis. The combination of two mark- ers can be used for better prediction of hepatocarcinoma.