OBJECTIVE:To explore the prognostic value of the postsurgical half-life (HL) of serum alpha-fetoprotein (AFP). BACKGROUND:There is still a paucity of early surrogate indicators of clinical endpoints after liver resection of hepatocellular carcinoma (HCC). METHODS:The analysis was based on cohorts of 225 (exploration set) and 117 (validation set) treatment-naïve HCC patients undergoing curative liver resection. We defined 3 categories of AFP HL: early complete resolution of AFP, normal HL, and prolonged HL if the HL exceeded 7 days. Overall, probabilities of recurrence and survival were estimated and compared across the AFP HL categories. RESULTS:In the exploration cohort, 48 patients (21.3%) achieved early AFP complete resolution, 116 (51.6%) had normal HL, and 61 (27.1%) had prolonged HL. Long AFP HL was significantly associated with early postoperative recurrence (P < 0.001), as was microvascular invasion. Early recurrence within 2 years of resection was observed in 59% of the patients with prolonged AFP HL compared with only 29.3% of those with normal AFP HL (P < 0.001). A log-rank test followed by multivariate Cox analysis identified an independent function of prolonged AFP HL in predicting shorter recurrence-free survival and overall survival time after HCC resection (hazard ratios, 2.81 and 3.58; P < 0.001). When AFP HL analysis was applied to the validation cohort, the association between prolonged AFP HL and survival endpoints (hazard ratio, 11.63 and 16.39; P < 0.001) was confirmed.

译文

目的:探讨血清甲胎蛋白(AFP)的术后半衰期(HL)的预后价值。
背景:肝切除肝细胞癌(HCC)后仍缺乏临床终点的早期替代指标。
方法:该分析基于225例(探索组)和117例(验证组)未进行过根治性肝切除的未接受治疗的HCC患者的分析。我们定义了AFP HL的3个类别:AFP的早期完全消退,正常HL和如果HL超过7天则延长HL。总体而言,在AFP HL类别中估计并比较了复发和生存的可能性。
结果:在探索队列中,有48例(21.3%)的患者达到了AFP的早期完全缓解,HL正常的116例(51.6%),HL延长的61例(27.1%)。长期AFP HL与微血管浸润与术后早期复发显着相关(P <0.001)。 AFP HL延长的患者中有59%的患者在切除的2年内出现了早期复发,而AFP HL正常的患者只有29.3%的患者出现了早期复发(P <0.001)。对数秩检验和多变量Cox分析确定了AFP HL延长在预测肝癌切除术后较短的无复发生存期和总生存期方面具有独立的功能(危险比,2.81和3.58; P <0.001)。当将AFP HL分析应用于验证队列时,证实了延长的AFP HL与生存终点之间的关联(风险比分别为11.63和16.39; P <0.001)。

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