The value of the Barcelona Clinic Liver Cancer and alpha-fetoprotein in the prognosis of hepatocellular carcinoma
The value of the Barcelona Clinic Liver Cancer and alpha-fetoprotein in the prognosis of hepatocellular carcinoma
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DOI：
10.4321/s1130-01082012000600003
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发表时间：
2012-06-01
期刊：
影响因子：
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通讯作者：
Sánchez-Ruano, Juan José
中科院分区：
文献类型：
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作者：
Gómez-Rodríguez, Rafael;Romero-Gutiérrez, Marta;Sánchez-Ruano, Juan José
导言和目标：目前评估肝细胞癌（HCC）患者预后的参考分期系统是“巴塞罗那临床肝癌”（BCLC）系统。甲胎蛋白（AFP）的值尚未得到适当的定义。本研究的目的是评估BCLC分类在我们的临床实践中，并了解AFP的预后价值是。材料和方法：136例连续肝癌患者前瞻性地纳入本研究。HCC的诊断是基于国际指南的建议。根据常规临床实践对患者进行研究和管理。生存曲线采用Kaplan-Meier法估计，生存预测因素采用考克斯模型确定。患者的平均年龄为66.62 ± 11.68岁。肝硬化91.2%。最常见的肝病原因是丙型肝炎感染（38.97%）。血清AFP 20-200 ng/mL者占20%，>200 ng/mL者占23%。根据BCLC分期标准，A期79例（58.09%），B期29例（21.32%），C期17例（12.50%），D期11例（8.09%）。总的中位生存时间为26.52个月（95%CI 16.7-36.3）。根据BCLC系统，中位生存期为：BCLC A 62.27个月，BCLC B 12.72个月，BCLC C 4.83个月，BCLC D 0.62个月（p < 0.0001）;根据血清AFP，中位生存期为：AFP < 20：62.27个月，> 20-200：22.08个月，> 200 ng/mL：5.39个月（p < 0.0001）。多因素分析显示AFP、BCLC分型和治疗是影响预后的独立因素。结论：BCLC是一个较好的预后指标。AFP对HCC患者的预后判断有一定价值。AFP的加入可以改善BCLC系统。未来的研究需要证实我们的结果，也是联合收割机BCLC和AFP正确结合的最佳方法。
Introduction and objectives: presently, the reference staging system to evaluate the prognosis of hepatocellular carcinoma (HCC) patients is "The Barcelona Clinic Liver Cancer" (BCLC) system. The value of alpha-fetoprotein (AFP) has not been properly defined. The aim of this study was to evaluate the BCLC classification in our clinical practice and to know what the prognostic value of AFP is.Material and methods: 136 consecutive HCC patients were prospectively included in this study. The diagnosis of HCC was based on the recommendation of international guidelines. The patients were studied and managed according to usual clinical practice. Survival curves were estimated using the Kaplan-Meier method and predictors of survival were identified using the Cox model.Results: 110 patients (80.9%) were male. The mean age of the patients was 66.62 +/- 11.68 years. Liver cirrhosis was present in 91.2%. The most frequent cause of liver disease was hepatitis C infection (38.97%). Serum AFP was 20-200 ng/mL in the 20%, and >200 ng/mL in 23%. According to the BCLC staging system, 79 patients were classified as stage A (58.09%), 29 (21.32%) stage B, 17 (12.50%) stage C and 11 patients (8.09%) as stage D. The overall median survival time was 26.52 months (95% CI 16.7-36.3). The median survival according to BCLC system was: BCLC A 62.27, BCLC B 12.72, BCLC C 4.83, and BCLC D 0.62 months (p < 0.0001); and according to serum AFP was: AFP < 20: 62.27 months, > 20-200: 22.08 months, and > 200 ng/mL: 5.39 months (p < 0.0001). Multivariate analysis showed that AFP, BCLC classification and treatment were independent prognostic factors.Conclusions: our results confirm that the BCLC is a good prognostic system. The AFP has prognosis value in HCC patients. The addition of AFP could improve the BCLC system. Future studies are needed to confirm our results and also the best way to combine BCLC and AFP properly.