摘要
目的建立一个基于术前血清甲胎蛋白(AFP)与碱性磷酸酶(ALP)的评分系统,并探讨其在可切除肝细胞癌(HCC)患者中的预后价值。方法回顾性纳入2016年1月—2019年8月在天津市第一中心医院以肝切除术作为初始治疗的154例HCC患者。通过受试者工作特征(ROC)曲线确定血清AFP与ALP的最佳临界值。采用Kaplan-Meier曲线和Log-rank检验进行生存分析,以评估AFP联合ALP评分与HCC患者无病生存(DFS)的关系。通过单因素及多因素Cox回归分析确定HCC患者的独立预后因素。符合正态分布的计量资料组间比较采用独立样本t检验;不符合正态分布的计量资料组间比较采用Mann-Whitney U检验。计数资料组间比较采用χ^(2)检验。结果ROC曲线显示,血清AFP预测DFS的最佳临界值为250.0 ng/mL,曲线下面积(AUC)为0.674(95%CI:0.580~0.767);血清ALP的最佳临界值为95.5 U/L,AUC为0.745(95%CI:0.652~0.838)。生存分析结果展示术前血清高AFP(≥250.0 ng/mL)和高ALP(≥95.5 U/L)均与HCC患者不良预后显著相关(P值均<0.001)。AFP联合ALP评分进一步将HCC患者分为0分(AFP<250.0 ng/mL且ALP<95.5 U/L)、1分(AFP≥250.0 ng/mL,ALP<95.5 U/L或AFP<250.0 ng/mL,ALP≥95.5 U/L)和2分(AFP≥250.0 ng/mL且ALP≥95.5 U/L)共3个研究组。生存曲线展示0分、1分和2分组患者的中位DFS分别为60.0(56.7~67.3)个月、20.0(1.4~36.6)个月和13.0(7.9~18.0)个月,组间生存差异均有统计学意义(P值均<0.05)。血清AFP联合ALP评分(1分vs 0分:HR=4.060,95%CI:2.050~8.039,P<0.001;2分vs 0分:HR=4.583,95%CI:2.385~8.805,P<0.001)是HCC患者的独立预后因素。结论基于血清AFP与ALP的联合评分能够有效识别预后不良的HCC患者,可作为HCC临床治疗中一项简便、可靠的预后评估工具。
Objective To establish a scoring system based on the preoperative serum levels of alpha-fetoprotein(AFP)and alkaline phosphatase(ALP),and to investigate its value in predicting the prognosis of patients with resectable hepatocellular carcinoma(HCC).Methods A retrospective analysis was performed for 154 HCC patients who underwent hepatectomy as the initial treatment in Tianjin First Central Hospital from January 2016 to August 2019.The receiver operating characteristic(ROC)curve was used to determine the optimal cut-off values of serum AFP and ALP;the Kaplan-Meier curve and the log-rank test were used for survival analysis to evaluate the relationship between the AFP-ALP score and disease-free survival(DFS);univariate and multivariate Cox regression analyses were used to identify the independent prognostic factors for HCC patients.The independent samples t-test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups;the chi-square test was used for comparison of categorical data between groups.Results The ROC curve analysis showed that serum AFP had an optimal cut-off value of 250.0 ng/mL and an area under the ROC curve(AUC)of 0.674(95%confidence interval[CI]:0.580-0.767)in predicting DFS,while serum ALP had an optimal cut-off value of 95.5 U/L and an AUC of 0.745(95%CI:0.652-0.838).The survival analysis showed that high preoperative serum levels of AFP(≥250.0 ng/mL)and ALP(≥95.5 U/L)were significantly associated with the poor prognosis of HCC patients(P<0.001).Based on the AFP-ALP score,all HCC patients were further divided into 0-point group(AFP<250.0 ng/mL and ALP<95.5 U/L),1-point group(AFP≥250.0 ng/mL,ALP<95.5 U/L;or AFP<250.0 ng/mL,ALP≥95.5 U/L),and 2-point group(AFP≥250.0 ng/mL and ALP≥95.5 U/L).The survival curves showed that the 0-,1-,and 2-point groups had a median DFS of 60.0(56.7-67.3)months,20.0(1.4-36.6)months,and 13.0(7.9-18.0)months,respectively,and there
作者
卢晶
张雅敏
李华
缪妍
LU Jing;ZHANG Yamin;LI Hua;MIAO Yan(The First Central Clinical College of Tianjin Medical University,Tianjin 300192,China;Department of Oncology,Baoding First Hospital,Baoding,Hebei 071000,China;Department of Hepatobiliary Surgery,Tianjin First Central Hospital,Tianjin 300192,China;Department of Anesthesiology,Baoding First Central Hospital,Baoding,Hebei 071000,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2023年第3期599-605,共7页
Journal of Clinical Hepatology
基金
天津市科技计划项目(19ZXDBSY00010)
保定市科技计划项目(2241ZF219)。
关键词
癌
肝细胞
甲胎蛋白类
碱性磷酸酶
预后
Carcinoma,Hepatocellular
alpha-Fetoproteins
Alkaline Phosphatase
Prognosis
