Value of α-fetoprotein in association with clinicopathological features of hepatocellular carcinoma
Value of α-fetoprotein in association with clinicopathological features of hepatocellular carcinoma
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DOI：
10.3748/wjg.v19.i11.1811
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发表时间：
2013-03-21
影响因子：
4.3
通讯作者：
Yang, Jia-Yin
中科院分区：
文献类型：
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作者：
Liu, Chang;Xiao, Guang-Qin;Yang, Jia-Yin
目的：深入探讨甲胎蛋白（AFP）与肝细胞癌（HCC）各种临床病理指标及不同分期体系的关系。方法：对2008年1月至2009年12月在华西医院连续诊断为HCC的患者进行回顾性队列研究。通过单因素分析和多因素分析，分析血清AFP值与HCC临床病理特征的关系，如乙型肝炎病毒（HBV）感染状况、肿瘤大小、肿瘤数量、血管浸润、肿瘤分化程度等。同时，根据入组时血清AFP值的截止值（= 801 μ g/L）不同，将患者分为4组，以各种临床病理变量分层，比较4组患者的阳性率。并比较不同肿瘤分期系统TNM、巴塞罗那临床肝癌（Barcelona Clinic Liver Cancer， BCLC）分期、China分期与血清AFP浓度的相关性。结果：本研究共纳入HCC患者2304例；血清AFP平均为555.3 +/- 546.6 mu g/L。27.4% （n = 631）的患者甲胎蛋白水平在正常范围内（< 20 μ g/L）。81.4% （n = 1875）的患者血清AFP水平明显高于非HBV感染者（573.9 +/- 547.7 mu g/L vs 398.4 +/- 522.3 mu g/L, P < 0.001）。肿瘤>= 10 cm （808.4 +/- 529.2 mu g/L）的AFP水平显著高于肿瘤大小为5-10 cm （499.5 +/- 536.4 mu g/L）和肿瘤大小为10 cm （OR 5.215, 95% CI: 1.426 ~ 13.151, P = 0.012）的AFP水平升高（AFP > 400 mu g/L）的独立预测因子。BCLC D期血清AFP水平（625.7 +/- 529.8 mu g/L）与A期（506.2 +/- 537.4 mu g/L）、B期（590.1 +/- 551.1 mu g/L）比较差异有统计学意义（P < 0.001）。结论：HCC的分化、大小和血管浸润与AFP有密切关系，分化差和HCC的大小>= 10 cm是AFP升高的独立预测因子。BCLC与AFP (C) 2013白石登关系较好。版权所有。
AIM: To explore the relationship between alpha-fetoprotein (AFP) and various clinicopathological variables and different staging system of hepatocellular carcinoma (HCC) thoroughly.METHODS: A retrospective cohort study of consecutive patients diagnosed with HCC between January 2008 and December 2009 in West China Hospital was enrolled in our study. The association of serum AFP values with the HCC clinicopathological features was analysed by univariate and multivariate analysis, such as status of hepatitis B virus (HBV) infection, tumor size, tumor number, vascular invasion and degree of tumor differentiation. Also, patients were divided into four groups at the time of enrollment according to different cutoff values for serum value of AFP (= 801 mu g/L), to compare the positive rate of patient among four groups stratified by various clinicopathological variables. And the correlation of different kinds of tumor staging systems, such as TNM, Barcelona Clinic Liver Cancer (BCLC) staging classification and China staging, were compared with the serum concentration of AFP.RESULTS: A total of 2304 HCC patients were enrolled in this study totally; the mean serum level of AFP was 555.3 +/- 546.6 mu g/L. AFP levels were within the normal range (< 20 mu g/L) in 27.4% (n = 631) of all the cases. 81.4% (n = 1875) patients were infected with HBV, and those patients had much higher serum AFP level compared with non-HBV infection ones (573.9 +/- 547.7 mu g/L vs 398.4 +/- 522.3 mu g/L, P < 0.001). The AFP level in tumors >= 10 cm (808.4 +/- 529.2 mu g/L) was significantly higher (P < 0.001) than those with tumor size 5-10 cm (499.5 +/- 536.4 mu g/L) and with tumor size = 10 cm) (OR 5.215, 95% CI: 1.426-13.151, P = 0.012) were independent predictors of elevated AFP concentrations (AFP > 400 mu g/L). Serum AFP levels differed significantly (P < 0.001) in the D stage of BCLC (625.7 +/- 529.8 mu g/L) compared with stage A (506.2 +/- 537.4 mu g/L) and B (590.1 +/- 551.1 mu g/L).CONCLUSION: HCC differentiation, size and vascular invasion have strong relationships with AFP, poor differentiation and HCC size >= 10 cm are independent predictors of elevated AFP. BCLC shows better relationship with AFP (C) 2013 Baishideng. All rights reserved.