甲胎蛋白阴性肝细胞癌患者的预后分析

Prognostic analysis of AFP-negative patients with hepatocellular carcinoma

目的:分析探讨影响甲胎蛋白(alpha fetoprotein,AFP)阴性(AFP<20 ng/mL)肝细胞癌(hepatocellular carcinoma,HCC)患者术后生存的风险因素。方法:共纳入479例接受根治性切除的HCC患者。采用单因素和多因素Cox回归分析确定AFP阴性HCC的预后因素。Kaplan-Meier法评估生存概率,并进行Log-rank检验。结果:年龄(HR=1.047,95%CI:1.002~1.094)、癌胚抗原(HR=1.151,95%CI:1.027~1.290)、糖类抗原19-9(HR=1.053,95%CI:1.002~1.105)、天冬氨酸氨基转移酶(HR=1.031,95%CI:1.001~1.070)及肿瘤大小(HR=1.289,95%CI:1.161~1.432)是AFP阴性HCC患者生存的独立风险因素。5个风险因素值的升高与AFP阴性HCC患者较差的预后相关,是影响总生存期(overall survival,OS)的危险因素(P<0.05)。AFP阴性HCC患者的OS明显长于AFP阳性HCC患者(P<0.001)。结论:接受手术治疗的AFP阴性HCC患者,需要注意其肝功能和肿瘤指标的检测,特别是年龄超过65岁、肿瘤超过6 cm的患者。

Objective:The study aims to determine the risk factors affecting postoperative survival in patients with alpha-fetoprotein(AFP)negative(AFP<20 ng/mL)hepatocellular carcinoma(HCC).Methods:A total of 479 patients with HCC who underwent radical resection were recruited in the current study.Independent prognostic factors for AFP-negative HCC patients were determined using univariate and multifactorial Cox regression analysis.The Kaplan-Meier method was used to assess the probability of survival,and log-rank tests were performed.Results:Age(HR=1.047,95%CI:1.002-1.094),carcinoembryonic antigen(HR=1.151,95%CI:1.027-1.290),carbohydrate antigen 19-9(HR=1.053,95%CI:1.002-1.105),aspartate aminotransferase(HR=1.031,95%CI:1.001-1.070)and tumor size(HR=1.289,95%CI:1.161-1.432)were independent risk factors for survival in AFP-negative HCC patients.The elevated values of the 5 risk factors had negative impacts on prognosis and were independent risk factors for overall survival(OS)(P<0.05).OS was longer in AFP-negative HCC patients than in AFP-positive HCC patients(P<0.001).Conclusion:AFP-negative patients undergoing surgical treatment for HCC are required attention to liver function and tumor markers,especially in patients older than 65 years and with tumor size larger than 6 cm.