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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)。KaplanMeier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。
Objective To explore the effect of serum AFP expression on staging system of hepatocellular carcinoma. Methods The clinical data of 725 hepatocellular carcinoma patients who were simply infected with hepatitis B virus (HBV) in our hospital from January 1999 to December 2010 were retrospectively analyzed. The TNM stage 7 (TNM) 7th), BCLC staging, Tokyo staging, JIS staging, CUPI staging, CLIP staging, and Okuda staging of postoperative hepatocellular carcinoma. Survival analysis was performed using Kaplan-Meier method and multivariate analysis was performed using the Cox proportional hazards model. AIC (Akaike Information Criterion) was used to determine the overall prognostic ability of each staging system. Results The majority of AFP positive patients had clinical symptoms such as pain (P = 0.047), high proportion of tumor (P = 0.039), poor proportion of tumor differentiation (P <0.001) and moderate and severe degree of cirrhosis (P = 0.008) , Higher Child-Pugh B grade (P = 0.042), and perioperative blood transfusion (P = 0.009). KaplanMeier survival curves and log-rank test showed that there was a statistically significant difference between the internal segments of BCLC and TNM 7th staging (P <0.05), which showed that both of the two staging were well differentiated. The AIC results showed that BCLC had the lowest AIC value (1618.642) in AFP-positive group and the smallest AIC value (863.514) in AFP-negative group, suggesting that BCLC in AFP-positive group had the best prognostic judgment TNM 7th has an advantage in AFP-negative groups. Conclusions AFP-positive patients often have poorer biological behavior and poorer liver backgrounds than AFP-negative patients. TNM 7th was the best staging standard for AFP-negative and BCLC was the best staging for AFP-positive. Therefore, the TNM 7th and BCLC staging still have limitations for the prognosis evaluation of Chinese HCC with HBV infection as the main cause. We should consider the serum AFP expression in the subsequent exploration of new staging.