甲胎蛋白与原发性肝癌临床病理特征及早期复发的关系

目的探讨术前血清甲胎蛋白(AFP)水平与肝癌临床病理特征、术后复发及无瘤生存期的关系。方法分析前瞻组77例和回顾组114例原发性肝癌患者术前血清AFP水平与肝癌的病理分级、肿瘤大小、有无肉眼癌栓和子灶、有无镜下微转移灶、术后复发及无瘤生存期的关系。结果前瞻组中,68例肝细胞癌患者病理Edmondson分级与术前血清AFP水平呈正相关;患者肿瘤大小、有无肉眼癌栓或子灶、有无镜下微转移灶和术后早期复发率与术前血清AFP水平呈正相关;术后随访4~12个月的无瘤生存期,术前血清AFP>1000μg/L组与血清AFP<20μg/L组和20~1000μg/L组相比,在P=0.0103水平有统计学意义,术前血清AFP>1000μg/L组较短,在P<0.05水平有统计学意义。回顾组中,肿瘤大小与术前血清AFP水平呈正相关,有无镜下微转移灶和术后早期复发率与术前血清AFP水平有统计学上正相关的趋势。结论术前血清AFP水平与肝癌的恶性程度有一定相关性,肝癌分化越差、直径越大。有肉眼癌栓或子灶或镜下微转移灶者,其术前血清AFP水平呈现增高趋势。术前血清AFP>1000μg/L可作为肝癌术后预后较差的一个指标。

The correlation of AFP with clinic-pathological features and early recurrence of primary liver cancer

Objective It is to explore the correlation of alpha-fetoprotein(AFP) with the clinic-pathological characteristics,the early recurrence rate and the tumor-free survival of primary liver cancer(PLC).Methods The correlation of preoperative AFP level with pathologic degree and size of the tumor,existence of macroscopic tumor thrombi or macrosatellites,existence of micrometastases,the early recurrence rate and the tumor-free survival were analyzed in the patients with PLC in prospective group and retrospective group.Results In prospective group,serum AFP level of 68 patients with hepatocellular carcinoma was positive related statistically to the pathological Edmondson grades,and that of 77 patients with PLC is positive related statistically to the tumor size,existence of macroscopic tumor thrombi or macrosatellites,existence of micrometastases and early recurrence rate.There were statisticant differences in postoperative tumor-free survival(P=0.010 3) among the three groups of preoperative serum AFP level >1 000 μg/L,20～1 000 μg/L and <20 μg/L.The average intervals from operation to recurrence of the former group were lower statistically than the later two groups in(P<0.05).In retrospective group,preoperative serum AFP level was positive related statistically with tumor size,and there was a statistical trend toward significance among the existence of micrometastases and the early recurrence rate.Conclusion Preoperative serum AFP level is related to the malignant degree of PLC.The more low differentiation is,the more large size will be.There is a increasing trend of preoperative serum AFP level in patients with macroscopic tumor thrombi or macrosatellites and with micrometastases. Preoperative serum AFP 1 000 μg/L may be used as an index of bad prognosis for PLC.