CAJ | 학술논문

目的探索血清AFP表达对于肝细胞癌分期系统的影响。方法回顾性分析1999年1月至2010年12月本院外科治疗的单纯感染乙型肝炎病毒（hepatitis B virus， HBV）的725例肝细胞癌患者的临床资料，比较TNM分期第七版（TNM 7th）、BCLC分期、Tokyo分期、JIS分期、CUPI分期、CLIP分期以及Okuda分期对肝细胞癌术后生存情况的判断力。采用Kaplan-Meier法进行生存分析，采用Cox比例风险模型进行多因素分析。应用AIC（Akaike Information Criterion，赤池宏治信息准则）来判断各分期系统对预后总的评估能力。结果 AFP阳性患者多具有疼痛等临床症状（P＝0.047），较高的肿瘤多发比例（P＝0.039），较差的肿瘤分化比例（P＜0.001），中重度肝硬化比例（P＝0.008），较高的Child-Pugh B级比例（P＝0.042）以及围手术期输血比例（P＝0.009）。Kaplan-Meier生存曲线及log-rank检验结果显示，BCLC与TNM 7th分期的内部各期之间有明显统计学差异（P＜0.05），显示这两个分期均具有良好的区分度。AIC结果显示：AFP阳性组中，BCLC具有最小的AIC值（1618.642），AFP阴性组中，TNM 7th具有最小的AIC值（863.514），提示AFP阳性组中BCLC具有最佳的预后判断力，而AFP阴性组中TNM 7th具有优势。结论相比于AFP阴性患者，AFP阳性患者多具有较差的生物学行为以及较差的肝脏背景。TNM 7th是AFP阴性组最好的分期标准，而BCLC是AFP阳性组最佳分期标准。因此提示，TNM 7th和BCLC分期对于以HBV感染为主要病因的中国HCC的预后评价仍具有局限性，我们在以后新分期探索的过程中应考虑到血清AFP表达这个因素。
목적탐색혈청AFP표체대우간세포암분기계통적영향。방법회고성분석1999년1월지2010년12월본원외과치료적단순감염을형간염병독（hepatitis B virus， HBV）적725례간세포암환자적림상자료，비교TNM분기제칠판（TNM 7th）、BCLC분기、Tokyo분기、JIS분기、CUPI분기、CLIP분기이급Okuda분기대간세포암술후생존정황적판단력。채용Kaplan-Meier법진행생존분석，채용Cox비례풍험모형진행다인소분석。응용AIC（Akaike Information Criterion，적지굉치신식준칙）래판단각분기계통대예후총적평고능력。결과 AFP양성환자다구유동통등림상증상（P＝0.047），교고적종류다발비례（P＝0.039），교차적종류분화비례（P＜0.001），중중도간경화비례（P＝0.008），교고적Child-Pugh B급비례（P＝0.042）이급위수술기수혈비례（P＝0.009）。Kaplan-Meier생존곡선급log-rank검험결과현시，BCLC여TNM 7th분기적내부각기지간유명현통계학차이（P＜0.05），현시저량개분기균구유량호적구분도。AIC결과현시：AFP양성조중，BCLC구유최소적AIC치（1618.642），AFP음성조중，TNM 7th구유최소적AIC치（863.514），제시AFP양성조중BCLC구유최가적예후판단력，이AFP음성조중TNM 7th구유우세。결론상비우AFP음성환자，AFP양성환자다구유교차적생물학행위이급교차적간장배경。TNM 7th시AFP음성조최호적분기표준，이BCLC시AFP양성조최가분기표준。인차제시，TNM 7th화BCLC분기대우이HBV감염위주요병인적중국HCC적예후평개잉구유국한성，아문재이후신분기탐색적과정중응고필도혈청AFP표체저개인소。
Objective To evaluate seven different staging systemsfor alpha-fetoprotein expression in hepatocellular carcinoma after hepatectomy. Methods This study analyzed 725 HBV-related Chinese HCC patients who received surgery first from January, 1999 to December, 2010 at the Hepatobiliary Surgery Center, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China. Predictive values of 7 different commonly used staging systems in clinic were evaluated as followed:Tumor-Node-Metastasis classification system, the Barcelona Clinic Liver Cancer staging system (BCLC), Tokyo score, the Japan Integrated Staging score (JIS),the model for the Chinese University Prognostic Index grade (CUPI),Cancer of the Liver Italian Program score (CLIP) and the Okuda staging. Kaplan-Meier survival estimates were plotted and P values were assessed using log-rank tests. Results The AFP-positive group exhibited characteristics of positive symptomatic presentation (P = 0.047), tumor multiplicity (P = 0.039), low grade differentiation (P < 0.001)and poor liver function for Child–Pugh B classification (P = 0.042) and moderate/severe cirrhosis (P = 0.008) and an increase inoperative difficulties (transfusion) (P=0.009). Significant survival difference was found across all groups of TNM7th&BCLC staging systems (P <0.05), showing both the 2 staging system had better ability of stratification.By further study, the BCLC staging showed the lowest AIC value (1618.642) for the AFP-positive group, while the TNM7th staging system displayed the lowest AIC values (863.514) for the AFP-negative group. Conclusions AFP-positive group displayed characteristics of poor tumor biological behavior and poor liver function. BCLC staging is optimal for the AFP-positive group,while TNM7th is a more appropriate staging model for the alternative group. As an independent prognostic factor forthe prognosis of HCC, AFP should be applied as a variant for the new staging system for the Chinese population.