原发性肝癌患者AFP浓度与临床特点及预后的相关性

Analysis of the relationship between the serum alpha-fetoprotein concentration and clinical characteristics and prognosis with primary liver cancer

目的甲胎蛋白（alpha fetoprotein，AFP）是原发性肝癌（primary livercancer，PLC）诊断的最主要的特异性标志物，但能否用于高危人群的早期发现以及帮助预后管理，仍存在争议。本研究探讨我国肝癌高发区顺德地区血清中AFP浓度的升高与PLC病例的临床特点及术后复发的关系，为临床诊治提供依据。方法收集2010-09-01-2014-10-01在顺德第一人民医院确诊为PLC患者601例，采用非条件Logistic回归模型探讨影响血清AFP浓度升高的临床特征因素，并分析血清AFP浓度与肝癌术后复发的关系。结果在601例PLC患者中，64．6％的肝癌患者（n=388）AFP浓度升高（AFP〉20μg／L）。经多因素模型分析显示，在校正了性别、年龄后，乙肝感染史（0R=2．43，95％CI=1．62～3．66）、门静脉癌栓形成（OR=2．34，95％CI=1．54～3．56）、手术治疗史（OR=0．51，95％CI=0．33～0．78）和TACE治疗史（OR=1．72，95％CI=1．19～2．50）仍与AFP浓度升高（AFP〉400μg／L）有相关性。此外，术前血清中AFP升高（〉400μg／L）可显增加肝癌术后1年复发风险（OR=2．78，95％CI=1.29～6．01）。结论HBV感染和门静脉癌栓形成是AFP升高的独立预测因素，AFP〉400μg／L的肝癌有较差的肝脏背景和较大的肿瘤负荷，而术前AFP〉400μg／L可能预示术后肝癌复发。

OBJECTIVE Alpha-fetoprotein （AFP） is the main specific marker diagnosis of primary liver cancer, but early detection high risk of PLC and to help the prognosis management remains controversial. This study is to investigate the relationship between alpha-fetoprotein （AFP） and various clinical characteristic variables and recurrence of the Prima- ry liver cancer （PLC） thoroughly. METHODS A total of 601 patients with PLC were included from the First People＇s Hospital of Shunde during on September 1,2010 to October 1,2014. Multivariate logistic regression analysis was per- formed to explore the influence the clinical characteristics on the increased AFP,in addition to analysis the relationship be- tween the serum concentration of AFP and Primary liver cancer 1-year recurrence. RESULTS A total of 64.6% （n=388） patients presented the elevated level of AFP in the first diagnosis. Multivariate logistic regression analysis showed that the Hepatitis B virus（HBV） infection（OR=2, 43,95%CI= 1. 62-3. 66） ,the presence of portal vein（OR= 2.34,95%CI= 1.54-3.56）, treatment method surgery （ OR = 0. 51,95 % CI = 0. 33 - 0. 78）, TACE treatment （ OR = 1. 72,95% CI= 1.19-2.50）were significantly associated with the increased AFP level adjusted to age and sex. In the patients treated with surgery, the 1-year recurrence-free survival rates were significant different in the AFP〉400 μg/L groups （OR= 2.78, 95 %CI= 1.29-6.01）. CONCLUSIONS HBV infection and portal vein thrombosis are the independent predictors for the elevated level of AFP. AFP〉400 μg/L of Primary liver cancer has a poor background and a large liver tumor burden. The preoperative serum AFP〉400 μg/L may predict the tumor recurrence after hepatectomy.