摘要
目的探讨肝细胞癌(hepatocellular carcinoma,HCC)患者肝移植术后的血清甲胎蛋白 (α-fetoprotein,AFP)变化与肝癌复发的关系。方法回顾性分析我院67例HCC患者肝移植手术前后的AFP动态变化与肝癌复发的关系。根据肝移植术前血清AFP水平,将患者分成3组,分别为A 组(术前血清AFP≤20 ng／ml)、B组(20 ng／ml<术前血清AFP≤400 ng/ml)和C组(术前血清AFP> 400 ng／ml),根据术后AFP的下降程度,将B组和C组患者分成3个亚组,即血清AFP在术后2周内降至≤20 ng/ml(BCl组)、术后2周后至2个月内降至≤20 ng／ml(BC2组)和2个月内未降至≤20 ng/ml(BC3组)。结果 67例肝癌受体移植后平均随访时间为13．2个月,总体复发率为35．8％ (24／67),平均复发时间为(7．2±0．7)个月,常见的复发转移部位依次为肺、肝、骨骼和淋巴结等;C 组患者移植术后复发率为52．8％,显著高于A、B两组(C组比A组,x2=6．759,P=0．009;C组比B 组,x2=4．550,P=0．033),A组和B组复发率无明显差异(x2=0．435,P=0．510);BC1组和BC2组术前AFP水平无明显差异,BC3组术前AFP明显高于BC1组和BC2组,BC3组患者术后复发率高达 67．9％,明显高于BC1组的33．3％和BC2组的22．2%,BC1组和Bc2组复发率未见明显差异。结论术前AFP水平>400 ng／ml的HCC肝移植患者术后复发率明显上升;术后AFP水平未能在 2个月内降至正常水平者复发率显著升高;移植后AFP的动态变化对预测HCC复发有重要价值。
Objective To evaluate serum α-fetoprotein（AFP） changes and tumor recurrence after liver transplantation （LT） for hepatocellular carcinoma （ HCC ） patients. Methods AFP levels of 67 patients with HCC before and after LT were analyzed retrospectively. According to the pre-LT AFP levels, patients were divided into three groups： group A （pre-LT AFP levels ≤ 20 ng/ml）, group B （20 ng/ml 〈 pre-LT AFP levels≤400 ng/ml） and group C（ pre-LT AFP levels 〉400 ng/ml）. Patients in group B and group C after putting together were further divided into three sub-groups according to the decline extent of AFP, i.e. group BC1 （ post-LT AFP levels decreased to ≤20 ng/ml within 2 weeks）, group BC2 （ post-LT AFP levels decreased to ≤0 ng/ml within 2 months） and group BC3 （ post-operation AFP levels did not decrease to ≤ 20 ng/ml within 2 months）. Results All 67 patients were followed up for an average of 13.2 months and the overall tumor recurrence and metastasis rate was 35.8% （24/67）. Recurrence was most often found in the lungs, the liver, bone marrow and lymph nodes. The recurrence rate in group C （52. 8% ） was higher than in group A and group B （ group C vs. group A, x^2 = 6. 759, P = 0. 009 ; group C vs. group B,x^2 =4. 550,P =0. 033）, the recurrence rate between group A and group B was not significantly different （ x^2 =0. 435, P =0. 510）. The pre-LT AFP levels and post-LT tumor recurrence rate in group BC3 （67.9%） were higher than in group BC1 and group BC2. Conclusions post-LT HCC recurrence and metastasis was higher in patients with pre-LT AFP level 〉 400 ng/ml and in those the post-LT AFP level failed to decrease to ≤20 ng/ml within 2 months. The dynamic changes of AFP after LT were valuable in predicting post-transplant HCC recurrence.
出处
《中华普通外科杂志》
CSCD
北大核心
2006年第5期351-353,共3页
Chinese Journal of General Surgery
基金
国家重点基础研究发展计划资助项目(2003CB515501)
浙江省科技厅基金资助项目(J20040701)
浙江省教育厅基金项目资助(20040223)
关键词
癌
肝细胞
肿瘤复发
局部
肝移植
甲胎蛋白类
Carcinoma, hepatocellular
Neoplasm recurrence,local
Liver transplantation
alpha-fetoproteins
