血清AFP表达对于单纯HBV感染的肝细胞癌分期系统的影响

摘要

目的探索血清AFP表达对于肝细胞癌分期系统的影响。方法回顾性分析1999年1月至2010年12月本院外科治疗的单纯感染乙型肝炎病毒（hepatitis B virus， HBV）的725例肝细胞癌患者的临床资料，比较TNM分期第七版（TNM 7th）、BCLC分期、Tokyo分期、JIS分期、CUPI分期、CLIP分期以及Okuda分期对肝细胞癌术后生存情况的判断力。采用Kaplan-Meier法进行生存分析，采用Cox比例风险模型进行多因素分析。应用AIC（Akaike Information Criterion，赤池宏治信息准则）来判断各分期系统对预后总的评估能力。结果 AFP阳性患者多具有疼痛等临床症状（P＝0.047），较高的肿瘤多发比例（P＝0.039），较差的肿瘤分化比例（P＜0.001），中重度肝硬化比例（P＝0.008），较高的Child-Pugh B级比例（P＝0.042）以及围手术期输血比例（P＝0.009）。Kaplan-Meier生存曲线及log-rank检验结果显示，BCLC与TNM 7th分期的内部各期之间有明显统计学差异（P＜0.05），显示这两个分期均具有良好的区分度。AIC结果显示：AFP阳性组中，BCLC具有最小的AIC值（1618.642），AFP阴性组中，TNM 7th具有最小的AIC值（863.514），提示AFP阳性组中BCLC具有最佳的预后判断力，而AFP阴性组中TNM 7th具有优势。结论相比于AFP阴性患者，AFP阳性患者多具有较差的生物学行为以及较差的肝脏背景。TNM 7th是AFP阴性组最好的分期标准，而BCLC是AFP阳性组最佳分期标准。因此提示，TNM 7th和BCLC分期对于以HBV感染为主要病因的中国HCC的预后评价仍具有局限性，我们在以后新分期探索的过程中应考虑到血清AFP表达这个因素。%Objective To evaluate seven different staging systemsfor alpha-fetoprotein expression in hepatocellular carcinoma after hepatectomy. Methods This study analyzed 725 HBV-related Chinese HCC patients who received surgery first from January, 1999 to December, 2010 at the Hepatobiliary Surgery Center, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China. Predictive values of 7 different commonly used staging systems in clinic were evaluated as followed:Tumor-Node-Metastasis classification system, the Barcelona Clinic Liver Cancer staging system (BCLC), Tokyo score, the Japan Integrated Staging score (JIS),the model for the Chinese University Prognostic Index grade (CUPI),Cancer of the Liver Italian Program score (CLIP) and the Okuda staging. Kaplan-Meier survival estimates were plotted and P values were assessed using log-rank tests. Results The AFP-positive group exhibited characteristics of positive symptomatic presentation (P = 0.047), tumor multiplicity (P = 0.039), low grade differentiation (P < 0.001)and poor liver function for Child–Pugh B classification (P = 0.042) and moderate/severe cirrhosis (P = 0.008) and an increase inoperative difficulties (transfusion) (P=0.009). Significant survival difference was found across all groups of TNM7th&BCLC staging systems (P <0.05), showing both the 2 staging system had better ability of stratification.By further study, the BCLC staging showed the lowest AIC value (1618.642) for the AFP-positive group, while the TNM7th staging system displayed the lowest AIC values (863.514) for the AFP-negative group. Conclusions AFP-positive group displayed characteristics of poor tumor biological behavior and poor liver function. BCLC staging is optimal for the AFP-positive group,while TNM7th is a more appropriate staging model for the alternative group. As an independent prognostic factor forthe prognosis of HCC, AFP should be applied as a variant for the new staging system for the Chinese population.