肝癌化疗栓塞前后甲胎蛋白变化模式的临床意义

目的评价经导管动脉化疗栓塞前后血清甲胎蛋白(AFP)变化模式对原发性肝细胞癌(PHC)疗效的价值。方法回顾性分析2007年1月至2009年12月间符合纳入标准的127例PHC患者,所有病例均接受规律的经导管动脉化疗栓塞(TACE)治疗,然后将治疗前后血清AFP值的变化情况划分成转阴、下降、不变及上升等4种变化模式,并把纳入病例分成相应的A、B、C和D 4组,最后对各组进行疗效和生存等统计学分析。结果全部病例总缓解率19.7%;无进展率为71.7%;中位生存时间为18个月,3、6个月,1、2、和3年生存率分别为92.9%、84.3%、63.0%、22.8%和7.1%;A与B组,A与C组,A与D组,B与C组,B与D组的组间比较差异具有统计学意义(P<0.05)。一般体力状态和门静脉癌栓为影响PHC患者生存期的独立危险因素。结论血清AFP变化模式对PHC TACE后的疗效具有临床指导作用,转阴或下降模式的生存期与不变或上升模式相比,明显延长。

The transformation pattern of serum a-fetoprotein after transcatheter arterial chemoembolization in patients with hepatocellular carcinoma: its clinical significance

Objective To discuss the value of serum а-fetoprotein(AFP) transformation pattern after transcatheter arterial chemoembolization(TACE) for primary hepatocellular carcinomas in evaluating the clinical therapeutic effect and prognosis.Methods During the period from January 2007 to December 2009,a total of 127 consecutive patients with hepatocellular carcinoma were treated with TACE only,which was performed regularly.The AFP levels were determined before and after the treatment.The AFP transformation patterns after TACE were classified into group A(turned to negative),group B(obviously decreased),group C(unchanged) and group D(continuously rising).The data were statistically analyzed and the results were compared between each other groups.The cumulated survival rate,median survival time,prognostic factors and curative effect were analyzed by using statistical methods.Results The general remission rate was 19.7%,and the progression-free survival rate was 71.7%.The overall median survival time for all 127 patients was 18 months.The 3-month,6-month,1-year,20year and 3-year survival rates were 92.9%,84.3%,63.0%,22.8%,and 7.1%,respectively.Log-rank test showed that the differences between groups A and B,A and C,A and D,B and C as well as B and D were statistically significant(P < 0.05).Multivariate analysis indicated that physical condition and the presence of tumor thrombus in portal vein were the main independent risk factors influencing the survival time.Conclusion TACE can be safely and effectively performed in selected patients of hepatocellular carcinomas.The AFP transformation patterns after TACE can be used to evaluate the clinical effectiveness.Patients showing a negative or decreased AFP transformation pattern after TACE(group A and group B) can fairly expect a longer survival time than that the patients of group C and group D can anticipate.