术前甲胎蛋白水平在热消融治疗肝细胞癌中的预后价值

Prognostic value of preoperative AFP levels in thermal ablation

目的探索术前甲胎蛋白(AFP)水平在热消融治疗肝细胞癌(HCC)病人中的预后价值。方法回顾性分析临床诊断为HCC病人305例,均为单发直径<3 cm肿瘤,109例接受射频治疗,196例接受微波治疗,比较两组病人的远期疗效并统计分析病人的预后影响因素。结果 AFP≥400μg/L组和AFP<400μg/L组病人1、3、5累积生存率分别为83.6%、66.9%、49.8%和96.2%、90.0%、74.7%(P=0.001),1、3、5累积复发率分别为36.3%、61.2%、75.2%和17.6%、38.9%、59.0%(P=0.003)。COX多因素分析中,AFP≥400μg/L是影响术后生存和复发的独立危险因素。射频组和微波组1、3、5年累积生存率分别为91.7%、79.5%、65.8%和94.8%、82.4%、69.4%(P=0.211)。1、3、5年复发率分别为24.1%、50.6%、61.1%和21.4%、40.1%、59.7%(P=0.424)。结论 AFP≥400μg与肝癌预后的生存和复发密切相关,可作为早期肝癌病人术后预后的指标。早期肝癌射频和微波消融远期疗效无明显差异。

Objective To explore the prognostic value of preoperative AFP levels in thermal ab-lation in patients with hepatocellular carcinoma （HCC）.Methods 305 consecutive patients diagnosed as having HCC with single diameter 〈 3 cm were retrospectively analyzed.109 patients receieved ra-diofrequency （RF）and 196 patients were given microwave （MW）ablation in Eastern hepatobilliary Surgery Hospital.Cumulative survival rate and cumulative recurrence rate were observed and ana-lyzed.Results The 1-,3-and 5-year cumulative survival rate in patients with HCC of AFP ≥400μg/L group vs.AFP 〈400μg/L group was 83.6%,66.9%,49.8% vs.96.2%,90.0%,74.7% re-spectively （P=0.001）.The 1-,3-and 5-year cumulative recurrence rate in patients with HCC of AFP≥400μg/L group vs.AFP 〈400μg/L group was 36.3%,61.2%,75.2% vs.17.6%,38.9%, 59.0% respectively （P=0.003）.AFP ≥400μg/L was a significant risk factor for survival and recur-rence of overall patients.The 1-,3-and 5-year cumulative survival rate in patients with HCC of RF group vs.MW group was 91.7%,79.5%,65.8% vs.94.8%,82.4% and 69.4% （P=0.211）. The 1-,3-and 5-year cumulative recurrence rate in patients with HCC of RF group vs.MW group was 24.1%,50.6%,61.1% vs.21.4%,40.1%,59.7% respectively （P=0.424）.Conclusions AFP ≥400μg/L was closely related to survival and recurrence of HCC,and it may serve as a predic-tive factor for patients after thermal ablation.RF and MW ablation are both effective therapies,and there are no obvious differences between them in treating HCC.