Highlights for α-fetoprotein in determining prognosis and treatment monitoring for hepatocellular carcinoma

AIM:To explore the prognostic value in the monitoring of treatment efficacy of serial α-fetoprotein(AFP) in hepatocellular carcinoma(HCC) patients.METHODS:We searched MEDLINE,EMBASE and COCHRANE LIBRARY through April 21,2012,to find qualifying articles.Our overall search strategy included terms for HCC,AFP,treatment response,and prognosis.Literature was limited to English-language,human studies.Studies reporting cumulative survival rates were summa-rized qualitatively.For the prognostic meta-analysis,we undertook a series of meta-analyses that summarised the Cox proportional hazard ratios(HRs) by assuming a random effects model.With regards to the correlation of AFP change with radiologic response,the categorical dichotomous variables were assessed using Poisson relative risks(RRs),which were incorporated into the random effects model meta-analysis of accuracy prediction.Between-study heterogeneity was estimated by use of the I2 statistic.Publication bias was evaluated using the Begg funnel plot and Egger plot.Sensitivity analyses were conducted first by separating systemic treatment estimates from locoregional therapy estimates,evaluating different AFP response cut-off point effects,and exploring the impact of different study sizes.RESULTS:Of 142 titles identified in our original search,11 articles(12 clinical studies) met our criteria.Six studies investigated outcome in a total of 464 cases who underwent systemic treatment,and six studies investigated outcome in a total of 510 patients who received locoregional therapy.A random-effects model metaanalysis showed that AFP response was associated with an mortality HR of 0.55(95%CI,0.47-0.65) across HCC in overall survival(OS) and 0.50(95%CI,0.38-0.65) in progression-free survival.Restricting analysis to the six eligible analyses of systemic treatment,the pooled HRs were 0.64(95%CI,0.53-0.77) for OS.Limiting analysis to the six analyses of locoregional therapy,the pooled HRs for OS was 0.39(95%CI,0.29-0.53).We showed a larger pooled HR in the 50% definition studies(HR,0.67,95%CI,0.55-0.83) compared with that from the 20% definition studies(HR,0.41,95%CI,0.32-0.53).Restricting analysis to the four studies including over 100 patients individually,the pooled HR was 0.65(95%CI,0.54-0.79),with a pooled HR for OS of 0.35(95%CI,0.23-0.46) in the studies of less than 100 patients.As to radiological imaging,43.1%(155/360) of the patients in the AFP response group presented with a radiological overall response,while the response rate decreased to 11.5%(36/313) in the patients from theAFP nonresponse group.The RR of having no overall response was significantly lower in the AFP response group than the AFP nonresponse group(RR,0.67;95%CI,0.61-0.75).In terms of disease control rate,86.9%(287/330) in the AFP response group and 51.0%(153/300) in the AFP nonresponse group showed successful disease control,respectively.The RR of disease control failure,similarly,was significantly lower in the AFP response group(RR,0.37;95%CI,0.23-0.58).But these findings could be overestimates because of publication and reporting bias.CONCLUSION:HCC patients presenting with an AFP response are at decreased risk of mortality.In addition,patients with an AFP response also present with a higher overall response rate and disease control rate.

Liver metastasis is the only independent prognostic factor in AFP-producing gastric cancer

AIM:To investigate differences between common gastric cancer andα-fetoprotein(AFP)-producing gastric cancer according to the presence or absence of liver metastasis.METHODS:Between 1997 and 2011,1299 patients underwent gastrectomy for gastric cancer(GC)at our institute and their hospital records were reviewed retrospectively.Patients were immunohistochemically divided into two groups:23 patients(1.8%)with AFPproducing GC and 1276 patients(98.2%)without it.RESULTS:AFP-producing GC patients had a significantly higher incidence of deeper tumors,venous invasion,lymphatic invasion,lymph node metastasis,and liver metastasis and a poorer prognosis(P<0.005)than those without AFP-producing GC.However,multi-variate analysis revealed that AFP-positivity was not an independent prognostic factor.The prognosis of AFPproducing GC was similar to that of AFP-non producing GC according to the presence or absence of liver metastasis.Concerning recurrence,47.8%of patients(11/23)with AFP-producing GC and 20.0%of patients(256/1276)without AFP-producing GC exhibited recurrence.Liver metastasis[90.9%(10/11)]was the most prevalent in AFP-producing GC patients.Multivariate analysis revealed that liver metastasis was the only independent prognostic factor in AFP-producing GC(HR=17.6,95%CI:2.1-147.1;P=0.0081).CONCLUSION:AFP-producing GC is similar to common GC without liver metastasis,which should be specifically targeted in an effort to improve the prognosis of AFP-producing GC patients.

原发性肝癌监测与治疗策略前移的研究进展

原发性肝癌早期诊断和治疗对提高患者的生存率和预后至关重要。近年来,原发性肝癌在早期诊断、早期干预及术后复发管理等领域的研究推陈出新,越来越多研究为原发性肝癌的监测及治疗前移提供了依据。本综述通过梳理最新研究进展,总结了肝癌相关风险预测模型、早期预警标志物、早期筛查新技术、术后复发危险因素以及干预治疗策略前移等,以期为肝癌高危人群及术后患者的科学管理提供理论支撑。

骨扫描在肺癌和前列腺癌骨转移疗效监测及预后判断中的应用价值

目的探讨全身骨扫描在肺癌和前列腺癌骨转移疗效监测及预后判断中的应用价值。方法将40例肺癌患者和31例前列腺癌患者在系统治疗前1个月内及治疗≥3个月后分别行全身骨扫描,观察治疗前后骨转移灶的变化与肿瘤临床综合疗效的相关性。采用Kaplan-Meier法计算生存率,Log-rank检验及Cox回归模型分析影响肺癌或前列腺癌骨转移预后的危险因素。结果肿瘤临床综合治疗有效者(59.68%,37/62)的骨转移疗效明显好于无效者(40.32%,25/62)(P<0.05)。肺癌骨转移患者的1年生存率为54.5%,2年生存率为22.6%;前列腺癌骨转移患者的1年生存率为87.3%,2年生存率为72.3%。单因素及Cox多因素分析均显示:肺癌和前列腺癌骨转移患者的生存率与肿瘤类型及骨转移时长相关(P<0.05)。肺癌与前列腺癌分组行Cox多因素分析结果显示:肺癌骨转移的预后危险因素为病理类型、治疗前骨扫描病变范围及骨转移时长;而前列腺癌骨转移的预后与骨转移时长有关。结论全身骨扫描为肺癌和前列腺癌骨转移的疗效监测及预后判断提供了更丰富、更准确的信息。

TACE联合重组人p53腺病毒治疗对原发性肝癌患者免疫应答及预后的影响

目的:探讨TACE联合重组人p53腺病毒治疗对原发性肝癌患者免疫应答及预后的影响。方法:选取我院于2016年01月至2017年12月收治的60例中晚期原发性肝癌患者作为研究对象,分为对照组和研究组,每组30例。对照组采取经导管肝动脉化疗栓塞术(TACE)治疗,研究组在对照组基础上联合重组人p53腺病毒注射液治疗。比较两组患者近期临床疗效、两组患者治疗后1年存活率、生活质量情况,比较两组患者术前1天、术后1周、术后2周、术后4周的外周血免疫细胞水平以及甲胎蛋白(AFP)水平,同时观测两组患者治疗期间不良反应发生情况。结果:研究组近期临床治疗总有效率60.00%(18/30)显著高于对照组33.33%(10/30);两组患者治疗后1周各免疫细胞水平与治疗前相比无明显差异(P>0.05),但治疗2周和4周后两组患者CD8^(+)水平均显著下降,CD3^(+)、CD4^(+)水平以及CD4^(+)/CD8^(+)比值显著上升,且研究组改善程度显著优于对照组(P<0.05);研究组患者甲胎蛋白(AFP)水平相比对照组下降更明显(P<0.05);治疗期间研究组不良反应发生率20.00%与对照组16.67%相比,差异无统计学意义(P>0.05);对两组患者1年生存随访,结果显示研究组死亡3例,存活27例,对照组死亡10例,存活20例,两组生存期差异存在显著意义(log-rank P=0.030);且研究组半年后和1年后生活质量改善程度显著优于对照组(P<0.05)。结论:TACE基础上联合重组人p53腺病毒可以显著改善原发性肝癌患者免疫细胞水平和机体免疫应答功能,提高1年生存率以及改善患者预后。