甲胎球蛋白/肿瘤体积比对原发性肝癌根治术后患者复发的临床评估

Clinical evaluation of alpha fetal protein-tumor volume ratio on patient's recurrence after radical resection of hepatocellular carcinoma

目的研究甲胎球蛋白（AFP）／肿瘤体积比在评估原发性肝癌根治切除术后复发中的临床作用。方法回顾分析广西医科大学第四附属医院2006年1月-2011年12月行原发性肝癌根治术后复发的临床分期相同的30例患者的临床资料，根据临床随访复发的时间进行分组，其中半年内复发组（A组）18例，半年后复发组（B组）12例。比较两组间患者的术前AFP值、术前肿瘤体积、AFP／肿瘤体积比以及术后组织病理分化程度对原发性肝癌根治切除术后复发的影响，分析AFP／肿瘤体积与患者术后复发的关系。结果A、B两组术前肿瘤体积分别为（48．90±35．92）、（37．25±20．29）mL，两者比较，差异无统计学意义（P〉0．05）；A组术前AFP值为（140．06±106．22）ng／mL，明显比B组[（83．21±33．29）ng／mL]高，两组比较，差异有统计学意义（P〈0．05）；A组术后组织的病理分化程度为：高分化3例，中分化8例，低分化例7例，B组为：高分化7例，中分化3例，低分化2例，两组比较，差异有统计学意义（P〈0．05），A组的AFP／肿瘤体积比均值为（3．51±1．39），明显比B组（2．47±0．91）高，两组比较，差异有统计学意义（P〈0．05）。相关分析表明，AFP／肿瘤体积与原发性肝癌根治术后复发存在显著相关性（r=0．574，P=0．021），AFP／肿瘤体积比值越大原发性肝癌根治切除术后半年内复发的可能性越大。结论AFP／肿瘤体积比可以作为原发性肝癌根治切除术后复发的临床评估指标，当AFP／肿瘤体积比大于3．5时原发性肝癌根治切除术后患者半年内复发的可能性比较大。

Objective To study the clinical value of alpha fetal protein （AFP）-tumor volume ratio on the evaluation of recurrence after radical resection of hepatocellular carcinoma. Methods Clinical data from 30 patients who underwent radical resection of hepatocellular carcinoma and recurred in the same clinical stages admitted into Fourth Affiliated Hospital of Guangxi Medical University from January 2006 to December 2011 were retrospectively analyzed. According to recurrence time by follow-up visits, they were divided into group within half a year （group A, n = 18） and group after half a year （group B, n = 12）. The preoperative value of AFP, preoperative tumor volume, AFP-tumor volume ratio, and influence of postoperative histopathological differentiation degrees on recurrence after radical resection of hepatocellular carcinoma were compared in both groups in order to analyze the relationship between AFP-tumor volume ratio and postoperative recurrence. Results The tumor volume before surgery in the group A and group B were （48.90±35.92） mL and （37.25±20.29） mL respectively with no significant difference （P 〉 0.05）. In the group A, the preoperative value of AFP was （140.06±106.22） ng/mL, and was much higher than that in the group B of 183.21±33.29） ng/mL, which displayed a statistical difference （P 〈 0.05）. The postoperative histopathological differentiation degrees in the group A were high differentiation in 3 cases, moderate in 8 cases, and low in 7 cases. In the group B, they were 7± 3, and 2 cases correspondingly. After comparison between the two groups, there was a significant difference （P 〈 0.05）. The mean ratio of AFP and tumor volume in the group A was （3.51±1.39）, and was remarkably higher than that in the group B of （2.47±0.91） with a statistical difference （P 〈 0.05）. The outcomes demonstrated that there was remarkable correlation between AFP-tumor volume ratio and recurrence after radical resection of hepatoeellular carcinoma （r = 0.574, P = 0.021）. The higher the ratio of AFP and tumor volume was, the more possibly radical resection of hepatocellular carcinoma recurred within half a year. Conclusion The ratio of AFP and tumor volume can be considered as a clinical evaluation index of recurrence after radical resection of hepatocellular carcinoma. Meanwhile, and when AFP-tumor volume ratio is over 3.5, it probably leads to recurrence after radical resection of hepatocellular carcinoma within half a.year.