High pretreatment static and dynamic alpha‐fetoprotein values predict reduced overall survival in hepatocellular carcinoma
High pretreatment static and dynamic alpha‐fetoprotein values predict reduced overall survival in hepatocellular carcinoma
复制标题
高预处理静态和动态α-芬蛋白值可预测肝细胞癌的总生存率降低
DOI：
10.1177/2050640620972611
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发表时间：
2021-03-11
影响因子：
6
通讯作者：
Weinmann A
中科院分区：
文献类型：
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作者：
Czauderna C;Schmidtmann I;Koch S;Pilz L;Heinrich S;Otto G;Mittler J;Lang H;Kloeckner R;Düber C;Sprinzl MF;Worns MA;Galle PR;Marquardt JU;Weinmann A
肝细胞癌是世界上最致命的癌症之一。迫切需要新的预测和/或预测生物标记物来改善患者管理。甲胎蛋白(AFP)是一种公认的、应用广泛的肝细胞癌生物标志物。然而，静态AFP值的诊断准确性是有限的，临床潜力是一个正在进行的科学讨论的问题。我们在西方队列中评估了治疗前静态和动态AFP变量对肝细胞癌患者总体生存率的预后影响。回顾分析了1998至2014年间在美因茨约翰尼斯·古登堡大学治疗的确诊肝细胞癌患者(n=809)和两个可用的治疗前AFP值(AFP-SLOPE)。评估临床病理基线参数、治疗前静态值和AFP斜率。预后影响由Kaplan-Meier分析和Cox回归模型确定。治疗前高的静态和动态AFP变量与肝细胞癌患者的生存率降低有关。一些已知的临床参数，如Child-Pugh B级(P<；0.01)和C期(P&P<；0.001)，门静脉血栓(P&P<；0.001)和肝外扩散(P&L<；0.001)被确认为总体生存的独立预测因素。加入静态和/或动态AFP变量可增加曲线下的时间相关面积。值得注意的是，在预后较好的患者中，与静态AFP值相比，治疗前AFP斜率对总存活率的预测略强一些。治疗前的静态和动态AFP变量可预测肝细胞癌患者的总存活率。在已建立的预后参数中加入AFP-SLOPE可能会改善部分肝功能正常、无门静脉癌栓的肝细胞癌患者的预后分类。甲胎蛋白(AFP)是肝细胞癌(HC)最常用的生物标志物，但静态和动态AFP值的准确性有限，其预后意义尚存争议。治疗前高的静态和动态AFP变量与不同肿瘤分期和治疗方式的肝细胞癌患者存活率降低有关。在预后较好的患者中，与静态AFP值相比，治疗前的AFP斜率是更好的总体生存预测因子。在已建立的预后参数中加入AFP-SLOPE可能会改善肝细胞癌亚组的预后分类。
Hepatocellular carcinoma is one of the most lethal cancers worldwide. Novel prognostic and/or predictive biomarkers are urgently needed to improve patient management. Alpha‐fetoprotein (AFP) is a well‐established and widely used biomarker for hepatocellular carcinoma. However, diagnostic accuracy of static AFP values is limited and the clinical potential is a matter of ongoing scientific discussion. We here evaluated the prognostic impact of pretreatment static and dynamic AFP variables on overall survival of hepatocellular carcinoma patients in a Western cohort. Patients with confirmed hepatocellular carcinoma (n = 809) treated at the Johannes Gutenberg University Mainz between 1998 and 2014 and two available pretreatment AFP‐values (AFP‐slope) were retrospectively analysed. Clinicopathological baseline parameters, pretreatment static values and AFP‐slope were assessed. Prognostic impact was determined by Kaplan–Meier analyses and Cox regression models. High static and dynamic AFP variables prior to therapy were associated with reduced survival rates of hepatocellular carcinoma patients. Several known clinical parameters such as Child–Pugh B (p < 0.01) and C stage (p < 0.001), portal vein thrombosis (p < 0.001) and extrahepatic spread (p < 0.001) were confirmed as independent predictors for overall survival. Addition of static and/or dynamic AFP variable resulted in higher time‐dependent area under the curves. Notably, in patients with more favourable prognosis, AFP‐slope prior to therapy was a slightly stronger predictor for overall survival compared with static AFP values. Static and dynamic AFP variables prior to therapy are predictive for overall survival of hepatocellular carcinoma patients. Addition of AFP‐slope to established prognostic parameters might improve prognostic classification for a subgroup of hepatocellular carcinoma patients with preserved liver function and without portal vein tumour thrombosis. Alpha‐fetoprotein (AFP) is the most commonly used biomarker for hepatocellular carcinomas (HCCs), but accuracy of static and dynamic AFP values is limited and the prognostic significance is under debate. High static and dynamic AFP variables prior to therapy are associated with reduced survival rates of HCC patients across different tumour stages and treatment modalities. In patients with more favourable prognosis, AFP‐slope prior to therapy was a better predictor for overall survival in comparison with static AFP values. Addition of AFP‐slope to established prognostic parameters might improve prognostic classification for a subgroup of HCC.