Triple positive tumor markers predict recurrence and survival in early stage hepatocellular carcinoma
Triple positive tumor markers predict recurrence and survival in early stage hepatocellular carcinoma
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DOI：
10.1111/hepr.12277
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发表时间：
2014-09-01
影响因子：
4.2
通讯作者：
Baba, Hideo
中科院分区：
文献类型：
--
作者：
Nakagawa, Shigeki;Beppu, Toru;Baba, Hideo
目的肝切除术对于肝功能良好且符合米兰标准的肝细胞癌（HCC）患者是可行的。多项研究表明，HCC 肿瘤标志物、甲胎蛋白 (AFP)、甲胎蛋白凝集素反应分数百分比以及维生素 K 缺乏/拮抗剂-II 诱导的蛋白质是恶性潜能的良好预测因子。识别高度恶性的 HCC 病例非常重要，本研究的目的是阐明三阳性肿瘤标志物作为米兰标准内早期 HCC 预后因素的影响。方法本研究调查了 2001 年 1 月至 2009 年 5 月期间因米兰标准内的 199 例因 HCC 接受肝切除术的患者。根据阳性肿瘤数量分析累积无复发生存期 (RFS)、总生存期 (OS) 和临床病理参数。结果在肿瘤标志物三重阳性的患者中，5 年 RFS 和 OS 较差（分别为 17.1% 和 61.4%）。多变量分析显示，复发的独立危险因素是丙型肝炎病毒抗体阳性、HCC非初始治疗和肿瘤标志物三阳性，OS的独立危险因素是15分钟高吲哚菁绿保留率、最大肿瘤尺寸和肿瘤标志物三阳性。病理浸润性生长、微血管侵犯和中低分化程度与三种肿瘤标志物的数量显着相关。结论符合米兰标准的早期HCC三重阳性肿瘤标志物显示预后不良和恶性特征。这些标志物可以作为早期 HCC 恶性程度的有用预测因子。
AimHepatectomy is feasible for patients with hepatocellular carcinoma (HCC) with good hepatic function who meet the Milan criteria. Several studies have indicated that tumor markers of HCC, -fetoprotein (AFP), Lens culinaris agglutinin-reactive fraction of AFP percentage and protein induced by vitamin K absence/antagonist-II were good predictors of malignant potential. It is important to identify highly malignant cases of HCC, and the aim of this study was to clarify the impact of triple positive tumor markers as the prognostic factors for early stage HCC within the Milan criteria.MethodsThis study investigated 199 patients who underwent hepatectomy for HCC within the Milan criteria between January 2001 and May 2009. Cumulative recurrence-free survival (RFS), overall survival (OS) and clinicopathological parameters were analyzed according to the number of positive tumor markers.ResultsIn patients with triple positive tumor markers, 5-year RFS and OS was poor (17.1 and 61.4%, respectively). Multivariate analyses revealed independent risk factors for recurrence to be hepatitis C virus antibody positivity, non-initial treatment for HCC and triple positive tumor markers, and the independent risk factors for OS were high indocyanine green retention rate at 15min value, maximum tumor size and triple positive tumor markers. Pathologically invasive growth, microvascular invasion and moderate to poor differentiation were significantly related to the number of the three tumor markers.ConclusionTriple positive tumor markers for early stage HCC within the Milan criteria showed poor prognosis and malignant characteristics. These markers could be a useful predictor for the degree of malignant potential in early stage HCC.