甲胎蛋白阴性肝细胞癌患者预后分析
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南京医科大学第一附属医院检验学部

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江苏省实验诊断学重点实验室(ZDXKB2016005);国家临床重点专科


Prognostic Analysis of AFP-negative hepatocellular carcinoma underwent surgical resection
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    摘要:

    目的:分析探讨影响甲胎蛋白(Alpha-Fetoprotein, AFP)阴性(AFP<20ng/ml) 肝细胞癌(hepatocellular carcinoma, HCC)患者术后生存的风险因素。方法:本研究共纳入479例接受根治性切除的HCC患者。采用单因素和多因素cox回归分析确定AFP阴性HCC的预后因素。Kaplan-Meier法评估生存概率,并进行log-rank检验。结果:年龄 (HR=1.047,95% CI: 1.002-1.094), CEA (HR=1.151,95%CI: 1.027-1.290), CA19-9 (HR=1.053,95%CI: 1.002-1.105), AST (HR=1.031,95% CI: 1.001-1.070)及肿瘤大小(HR=1.289,95% CI: 1.161-1.432)是AFP阴性HCC患者生存的独立风险因素。5个风险因素值的升高与AFP阴性HCC患者较差的预后相关,是影响总生存率(overall survival, OS)的危险因素(P<0.05)。AFP阴性HCC患者的OS明显高于AFP阳性HCC患者 (P<0.001)。结论 HCC接受手术治疗的AFP阴性患者,需要注意肝功能和肿瘤指标的检测,特别是年龄超过65岁,肿瘤大小超过6cm的患者。

    Abstract:

    Objective The aim of the study was to determine the risk factors affecting postoperative survival in patients with alpha-fetoprotein (AFP) negative (AFP <20 ng/ml) hepatocellular carcinoma (HCC). Methods A total of 479 patients with HCC who underwent radical resection were included in this study. Independent prognostic factors for AFP-negative HCC patients were determined using univariate and multifactorial cox regression analysis. the Kaplan-Meier method was used to assess the probability of survival, and log-rank tests were performed. Result: Age (HR=1.047, 95% CI: 1.002-1.094), CEA (HR=1.151, 95% CI: 1.027-1.290), CA19-9 (HR=1.053, 95% CI: 1.002-1.105), AST (HR=1.031, 95% CI: 1,001-1.070) and tumor size (HR=1.289, 95% CI: 1,161-1.432) were independent risk factors for survival in AFP-negative HCC patients. Elevated values of the 5 risk factors had a negative impact on prognosis and were independent risk factors for overall survival (OS) (P<0.05). OS was higher in AFP-negative HCC patients than in AFP-positive HCC patients (P<0.001). Conclusion AFP-negative patients undergoing surgical treatment for HCC require attention to liver function and tumor indexes, especially in patients older than 65 years and with tumor size greater than 6 cm.

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  • 收稿日期:2023-05-29
  • 最后修改日期:2023-08-03
  • 录用日期:2023-10-25
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