肝细胞癌肝脏切除术后 AFP 和 PIVKA-II 血清学不完全转换的预后意义:对 1755 例患者的多中心分析。

IF 4.8 2区 医学 Q1 ONCOLOGY Oncologist Pub Date : 2024-12-06 DOI:10.1093/oncolo/oyae139
Mingda Wang, Guojun Qian, Hongmei Xiao, Xingkai Liu, Liyang Sun, Zhong Chen, Kongying Lin, Lanqing Yao, Chao Li, Lihui Gu, Jiahao Xu, Xiaodong Sun, Wei Qiu, Timothy M Pawlik, Wan Yee Lau, Guoyue Lv, Feng Shen, Tian Yang
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引用次数: 0

摘要

背景:血清生物标志物,尤其是甲胎蛋白(AFP)和维生素K缺失或拮抗剂-II(PIVKA-II)诱导蛋白,在肝细胞癌(HCC)患者的预后评估和复发监测中的价值日益受到关注。本研究探讨了这两种生物标志物的血清学不完全转换(SIC)作为预后指标对肝癌切除术后长期预后的影响:这项多中心观察性研究的对象是AFP(>20 ng/mL)或PIVKA-II(>40 mAU/mL)阳性并接受根治性切除术的HCC患者。根据术后首次随访(术后 4~8 周)时的 AFP 和 PIVKA-II 水平,这些患者被分为血清学不完全转化组(SIC)和血清学完全转化组(SCC)。研究终点为复发率和总生存率(OS):在 1755 例患者中,379 例和 1376 例分别被分为 SIC 组和 SCC 组。SIC组的1年和5年生存率分别为67.5%和26.3%,相应的复发率分别为53.2%和79.0%;而SCC组的1年和5年生存率分别为95.8%和62.5%,相应的复发率分别为16.8%和48.8%(均为P):结果强调,AFP或PIVKA-II术后未完全转阴是一个重要的预后标志,表明HCC切除术后出现不良肿瘤结局的风险较高。这一发现对完善 HCC 患者的术后辅助治疗和监测策略具有重要意义。
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Prognostic significance of postoperative serological incomplete conversion of AFP and PIVKA-II after hepatic resection for hepatocellular carcinoma: a multicenter analysis of 1755 patients.

Background: The value of serum biomarkers, particularly alpha-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II), gains increasing attention in prognostic evaluation and recurrence monitoring for patients with hepatocellular carcinoma (HCC). This study investigated the implications of serological incomplete conversion (SIC) of these 2 biomarkers as prognostic indicators for long-term outcomes after HCC resection.

Methods: A multicenter observational study was conducted on a cohort of HCC patients presenting with AFP (>20 ng/mL) or PIVKA-II (>40 mAU/mL) positivity who underwent curative-intent resection. Based on their postoperative AFP and PIVKA-II levels at first postoperative follow-up (4~8 weeks after surgery), these patients were stratified into the serological incomplete conversion (SIC) and serological complete conversion (SCC) groups. The study endpoints were recurrence and overall survival (OS).

Results: Among 1755 patients, 379 and 1376 were categorized as having SIC and SCC, respectively. The SIC group exhibited 1- and 5-year OS rates of 67.5% and 26.3%, with the corresponding recurrence rates of 53.2% and 79.0%, respectively; while the SCC group displayed 1- and 5-year OS rates of 95.8% and 62.5%, with the corresponding recurrence rates of 16.8% and 48.8%, respectively (both P < .001). Multivariate Cox regression analysis demonstrated that postoperative SIC was an independent risk factor for both increased recurrence (HR: 2.40, 95% CI, 2.04-2.81, P < .001) and decreased OS (HR: 2.69, 95% CI, 2.24-3.24, P < .001).

Conclusion: The results emphasize that postoperative incomplete conversion of either AFP or PIVKA-II is a significant prognostic marker, indicating a higher risk for adverse oncologic outcomes following HCC resection. This revelation has crucial implications for refining postoperative adjuvant therapy and surveillance strategies for HCC patients.

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来源期刊
Oncologist
Oncologist 医学-肿瘤学
CiteScore
10.40
自引率
3.40%
发文量
309
审稿时长
3-8 weeks
期刊介绍: The Oncologist® is dedicated to translating the latest research developments into the best multidimensional care for cancer patients. Thus, The Oncologist is committed to helping physicians excel in this ever-expanding environment through the publication of timely reviews, original studies, and commentaries on important developments. We believe that the practice of oncology requires both an understanding of a range of disciplines encompassing basic science related to cancer, translational research, and clinical practice, but also the socioeconomic and psychosocial factors that determine access to care and quality of life and function following cancer treatment.
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