Alpha-fetoprotein has no prognostic role in small hepatocellular carcinoma identified during surveillance in compensated cirrhosis
Alpha-fetoprotein has no prognostic role in small hepatocellular carcinoma identified during surveillance in compensated cirrhosis
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DOI：
10.1002/hep.25814
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发表时间：
2012-10-01
期刊：
影响因子：
13.5
通讯作者：
Trevisani, Franco
中科院分区：
文献类型：
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作者：
Giannini, Edoardo G.;Marenco, Simona;Trevisani, Franco
甲胎蛋白是一种肿瘤标志物，已被用于肝硬化患者肝细胞癌（HCC）的监测和诊断。该标志物在HCC患者中的预后能力尚未明确定义。在这项研究中，我们的目的是评估血清甲胎蛋白对代偿良好的肝硬化、最佳表现状态和在定期超声监测中发现的小肝癌患者的预后价值，这些患者接受了治疗目的的治疗。在意大利肝癌研究组数据库中纳入的3027例患者中，我们选择了205例Child-Pugh A级和Eastern Cooperative group Performance Status 0级患者，这些患者在监测期间诊断为肝硬化，单个HCC = 3cm直径，并以治愈为目的进行治疗（肝切除术、肝移植、经皮乙醇注射、射频热消融）。根据甲胎蛋白血清水平对患者进行细分（正常=20 ng/mL，轻度升高21 ~ 200 ng/mL，显著升高> ~ 200 ng/mL）。Kaplan-Meier法评估的患者生存率在三种甲胎蛋白类别之间无显著差异（P = 0.493）。在单个HCC =2 cm的患者亚组中获得了相同的结果（P = 0.714）。经受试者工作特征曲线鉴定的甲胎蛋白血清水平为100 ng/mL，其准确性不足（曲线下面积= 0.536,95%可信区间= 0.465-0.606），无法区分幸存者和死亡患者。结论：甲胎蛋白血清水平对代偿良好的肝硬化合并单纯性小肝癌患者无预后意义。(肝脏病学2012)
Alpha-fetoprotein is a tumor marker that has been used for surveillance and diagnosis of hepatocellular carcinoma (HCC) in patients with cirrhosis. The prognostic capability of this marker in patients with HCC has not been clearly defined. In this study our aim was to evaluate the prognostic usefulness of serum alpha-fetoprotein in patients with well-compensated cirrhosis, optimal performance status, and small HCC identified during periodic surveillance ultrasound who were treated with curative intent. Among the 3,027 patients included in the Italian Liver Cancer study group database, we selected 205 Child-Pugh class A and Eastern Cooperative Group Performance Status 0 patients with cirrhosis with a single HCC =3 cm of diameter diagnosed during surveillance who were treated with curative intent (hepatic resection, liver transplantation, percutaneous ethanol injection, radiofrequency thermal ablation). Patients were subdivided according to alpha-fetoprotein serum levels (i.e., normal =20 ng/mL; mildly elevated 21-200 ng/mL; markedly elevated >200 ng/mL). Patient survival, as assessed by the Kaplan-Meier method, was not significantly different among the three alpha-fetoprotein classes (P = 0.493). The same result was obtained in the subgroup of patients with a single HCC =2 cm (P = 0.714). An alpha-fetoprotein serum level of 100 ng/mL identified by receiver operating characteristic curve had inadequate accuracy (area under the curve = 0.536, 95% confidence interval = 0.465-0.606) to discriminate between survivors and deceased patients. Conclusion: Alpha-fetoprotein serum levels have no prognostic meaning in well-compensated cirrhosis patients with single, small HCC treated with curative intent. (HEPATOLOGY 2012)