甲胎蛋白联合纤维蛋白原与白蛋白比值评分系统在肝细胞癌预后中的应用价值

Application value of Alpha-fetoprotein combined with fibrinogen to albumin ratio scoring system in the prognosis of hepatocellular carcinoma

目的探讨甲胎蛋白(alpha-fetoprotein,AFP)联合纤维蛋白原(Fibrinogen,Fib)与白蛋白比值(Fibrinogen to Albumin ratio,FAR)评分系统在对肝细胞癌(hepatocellular carcinoma,HCC)患者诊断中的应用价值。方法回顾性分析了2013年6月至2014年5月间蚌埠医学院第一附属医院收治的157例行根治性肝切除肝细胞肝癌患者的临床资料,包括年龄、性别、吸烟、饮酒、乙型病毒性肝炎、Child-Pugh分级、肿瘤部位、肿瘤大小、TNM分期、甲胎蛋白、纤维蛋白原、血小板(Platelet,PLT)、FAR,通过受试者工作特征曲线(receiver operating characteristic curve,ROC)分析确定Fib、PLT、FAR的最佳截止点。根据AFP-FAR(AFP and FAR,A-FAR)组评分分为3组:A-FAR 0分、A-FAR 1分、A-FAR 2分。通过卡方检验分析其与临床病理因素之间的关系,采用Kaplan-Meier法进行生存分析,采用log-rank法进行差异性检验,单因素和多因素回归分析采用Cox比例风险模型。结果根据ROC确定Fib、PLT、FAR的最佳截止值分别为5.75g/L、157×10^9/L和0.07。年龄、乙型病毒性肝炎、肿瘤直径、Child-Pugh分级与术前A-FAR评分相关(P<0.05)。单因素分析表明:肿瘤部位、肿瘤直径、TNM分期、AFP、Fib、PLT、FAR、A-FAR与预后相关(P<0.05)。多因素分析进一步表明:肿瘤部位、肿瘤直径、PLT、FAR及A-FAR是根治性肝切除肝细胞肝癌预后的独立危险因素(P<0.05)。结论A-FAR是影响肝细胞癌患者术后预后的独立危险因素,A-FAR评分较高提示肝细胞癌患者术后预后较差。

Objective To investigate the application value of alpha-fetoprotein(AFP)combined with fibrinogen(Fib)and albumin ratio(FAR)scoring system in patients with hepatocellular carcinoma(HCC).Methods The clinical data of 157 patients with hepatocellular carcinoma who underwent radical hepatectomy in the first affiliated hospital of Bengbu Medical College from June 2013 to May 2014 were analyzed retrospectively.The clinical data included age,gender,smoking,alcohol consumption,hepatitis B virus,Child-Pugh classification,tumor site,tumor size,TNM stage,AFP,Fib,platelet(PLT),FAR,and the optimal cut-off points for Fib,PLT,FAR were determined by receiver operating characteristic curve(ROC)analysis.According to the A-FAR(AFP and FAR)group score,all data were divided into 3 groups:A-FAR 0 points,A-FAR 1 point,A-FAR 2 points.Chi-square test was used to analyze its relationship with clinicopathological factors.Kaplan-Meier method was used for survival analysis.Log-rank method was used for difference test.Univariate and multivariate regression analysis used Cox proportional hazard model.Results According to the ROC curve,the optimal cut-off values for Fib,PLT and FAR were 5.75g/L,157×10^9/L and 0.07,respectively.Age,hepatitis B virus,tumor diameter,and Child-Pugh classification were related to preoperative A-FAR score(P<0.05).Univariate analysis showed that:tumor site,tumor diameter,TNM stage,AFP,Fib,PLT,FAR,A-FAR were associated with prognosis(P<0.05).Multivariate analysis further showed that tumor site,tumor diameter,PLT,FAR and A-FAR are independent risk factors for the prognosis of radical hepatectomy for hepatocellular carcinoma(P<0.05).Conclusion A-FAR is an independent risk factor that affects the postoperative prognosis of patients with hepatocellular carcinoma.A higher A-FAR score indicates a poorer prognosis for patients with hepatocellular carcinoma.