术前血清甲胎蛋白水平与肝细胞癌术后患者早期复发的相关性分析

摘要

Objective To study the relationship between preoperative serum a-fetoprotein (AFP) level and early recurrence of patients with hepatocellular carcinoma (HCC) after partial hepatectomy.Methods 267 patients with hepatocellular carcinoma who underwent partial hepatectomy in Xijing Hospital,the Fourth Military Medical University from January 2011 to November 2015 were retrospectively studied.The patients were divided into the AFP-negative group (AFP ≤20 μg/L) and the AFP-positive group (AFP ＞ 20 μg/L) according to the preoperative serum AFP levels.The risk factors of early recurrence of HCC in patients after partial hepatectomy were studied by multivariate regression analysis.The recurrence-free survival rates during 24 months after surgery between the AFP-negative group and the AFP-positive group were compared.Results In 267 patients,97 patients had low or negative AFP levels (AFP≤20 μg/L) and 170 patients had high or positive AFP levels (AFP ＞ 20 μg/L).Patients in the AFP-positive group had significantly more well differentiated HCC on tumor histology when compared with patients in the AFP-negative group (x2 =17.050,P ＜ 0.05).The proportion of patients with liver cirrhosis in the AFP-positive group was significantly higher than that of the AFP-negative group (x2 =4.374,P ＜ 0.05).On the other hand,the numbers of patients with adjacent tissue invasion (x2 =4.374,P ＜ 0.05) and early HCC recurrence (x2 =7.595,P ＜ 0.05) in the AFP-positive group were significantly less than those of the AFP-negative group.Survival analysis showed that the recurrence-free survival rates in the AFP-positive and negative groups were 35.3％,52.6％,respectively.The results on univariate analysis showed that portal vein tumor thrombus,HBsAg positivity,tumor number,tumor diameter,tumor tissue differentiation,preoperative serum AFP level and adjacent tissue invasion were significantly associated with early recurrence of liver cancer (P ＜ 0.05).Cox multivariate regression analysis revealed that serum AFP positivity (HR =1.605,P ＜ 0.05),portal vein tumor thrombosis (HR =3.936,P ＜ 0.05),HBsAg positivity (HR =1.621,P ＜0.05),tumor diameter (HR =1.977,P ＜ 0.05) and tumor number (HR =1.991,P ＜ 0.05) were significantly correlated with early recurrence of liver cancer after partial hepatectomy.Conclusion The preoperative serum AFP level had an important predictive value for early recurrence of primary hepatocellular carcinoma in patients after partial hepatectomy.%目的 探讨肝癌患者术前血清AFP水平与患者术后早期复发的关系.方法 回顾性分析2011年1月至2015年11月第四军医大学西京医院267例肝癌切除术患者资料.根据术前血清AFP水平将患者分为AFP≤20 μg/L(阴性组)和AFP＞ 20μg/L(阳性组)两组.比较两组患者临床病理特征、术后早期复发与术前血清AFP水平的关系,并通过多因素回归分析HCC术后早期复发的危险因素.结果 267例患者中,AFP阴性组97例,AFP阳性组170例.与AFP阳性组比较,AFP阴性组肝癌组织分化程度较高(x2=17.050,P＜0.05),而肝硬化(x2=4.374,P＜0.05)、邻近组织侵犯(x2=4.374,P＜0.05)和早期复发(x2=7.595,P＜0.05)的比例明显降低.生存分析显示,阳性组和阴性组术后24个月无瘤生存率分别为35.3％、52.6％.COX单因素分析显示,门静脉癌栓、HBsAg阳性、肿瘤数目、肿瘤直径、组织分化、术前血清AFP水平以及邻近组织侵犯与肝癌术后早期复发相关(P＜0.05).COX多因素回归分析显示,血清AFP阳性(HR=1.605,P＜0.05)、门静脉癌栓(HR=3.936,P ＜0.05)、HBsAg阳性(HR=1.621,P ＜0.05)、肿瘤直径(HR=1.977,P＜0.05)和肿瘤数目(HR=1.991,P＜0.05)与肝癌术后早期复发密切相关.结论 术前血清AFP水平对肝癌患者早期复发具有重要的预测价值.