早期AFP应答对经肝动脉化疗栓塞术后中期肝细胞癌患者预后的预测价值被引量：8

Early alpha-fetoprotein response can predict the prognosis of patients with intermediate-stage hepatocellular carcinoma treated with transarterial chemoembolization

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摘要目的对AFP应答进行最佳定义并探讨AFP应答与经肝动脉化疗栓塞术(TACE)治疗BCLC-B期肝细胞癌疗效的关系。方法回顾性纳入2010年1月-2014年12月在西京消化病医院消化介入科行TACE治疗连续的中期肝细胞癌患者116例,利用受试者工作特征曲线确定AFP变化率的最佳临界值,将术后AFP降低程度大于临界值的定义为AFP应答(AFP-R)组,其余为AFP不应答(AFP-NR)组。采用Kaplan-Meier法进行生存分析,生存时间的比较采log-rank检验,利用Cox回归进行多因素预后分析。结果中位肿瘤大小为7.5 cm,112例(96.6%)患者的肝功能为Child-Pugh A级。术后1个月AFP较基线降低16%为最佳临界值。AFP-R组的生存明显高于AFP-NR组,中位生存时间分别为26.6(20.9~32.3)个月和7.0(5.2~8.8)个月[风险比(HR)=3.56,95%可信区间(95%CI):2.12~5.95,P<0.001],在亚组分析中同样能证实AFP-R组的预后明显优于AFPNR组(P值均<0.05),多因素分析发现年龄(HR=0.97,95%CI:0.95~0.99,P=0.003)、肿瘤大小(HR=1.14,95%CI:1.06~1.22,P<0.001)、ECOG体能评分(HR=2.15,95%CI:1.24~3.73,P=0.006,)、AFP应答(HR=1.56,95%CI:2.12~5.95,P<0.001)是影响患者生存的独立危险因素。结论早期AFP应答可预测经TACE治疗的中期肝细胞癌患者的预后。 Objectives To investigate the best definition of alpha - fetoprotein （AFP） response and its association with the outcome of pa- tients with BCLC stage B hepatocellular carcinoma （HCC） treated with transarterial chemoembolization （TACE）. Methods A retrospective analysis was performed for the clinical data of 116 patients with intermediate - stage HCC who were treated with TACE in Department of Liver Disease and Digestive Interventional Radiology in Xijing Hospital of Digestive Disease from January 2010 to December 2014. The receiver operating characteristic curve was used to determine the optimal cut - off value of AFP change rate. The patients with a reduction in AFP greater than the cut -off value after surgery were defined as AFP response group （AFP -R group）, and the other patients were defined as AFP non - response group （ AFP - NR group）. The Cox regression model was used for multivariate prognostic analyses. Results The medi- an tumor size was 7.5 cm, and of all patients, 112 （96.6%） had Child - Pugh class A liver function. The optimal cut - off value was de- fined as a 16% reduction in AFP at 1 month after surgery, compared with baseline. The AFP - R group had a significantly longer median survival time than the AFP - NR group （26.6 （20.9 - 32.3 ） months vs 7.0 （ 5.2 - 8.8） months, HR = 3.56, 95% CI ： 2.12 - 5.95, P 〈 0. 001 ）. The sub - group analysis showed that the AFP - NR group had significantly better prognosis than the AFP - NR group （ P 〈 O. 05 ）. The multivariate analysis showed that age （ HR = 0.97, 95% CI ： 0.95 - 0.99, P = 0. 003）, tumor size （ HR = 1. 14, 95% CI ： 1.06 - 1.22, P 〈 0. 001 ） , Eastern Cooperative Oncology Group performance score （ HR = 2.15, 95% CI ： 1.24 - 3.73, P = 0. 006） , and AFP re- sponse （ HR = 1.56, 95% CI： 2.12 -5.95, P 〈 0. 001 ） were independent risk factors for patients＇ survival. Conclusion Early AFP response can predict the prognosis of patients with intermediate - stage HCC treated with T