【摘要】 目的探讨肝细胞癌(hepatocellular carcinoma,HCC)患者肝移植术后的血清甲胎蛋白 (α-fetoprotein,AFP)变化与肝癌复发的关系。方法回顾性分析我院67例HCC患者肝移植手术前后的AFP动态变化与肝癌复发的关系。根据肝移植术前血清AFP水平,将患者分成3组,分别为A 组(术前血清AFP≤20 ng／ml)、B组(20 ng／ml<术前血清AFP≤400 ng/ml)和C组(术前血清AFP> 400 ng／ml),根据术后AFP的下降程度,将B组和C组患者分成3个亚组,即血清AFP在术后2周内降至≤20 ng/ml(BCl组)、术后2周后至2个月内降至≤20 ng／ml(BC2组)和2个月内未降至≤20 ng/ml(BC3组)。结果 67例肝癌受体移植后平均随访时间为13．2个月,总体复发率为35．8％ (24／67),平均复发时间为(7．2±0．7)个月,常见的复发转移部位依次为肺、肝、骨骼和淋巴结等;C 组患者移植术后复发率为52．8％,显著高于A、B两组(C组比A组,x2=6．759,P=0．009;C组比B 组,x2=4．550,P=0．033),A组和B组复发率无明显差异(x2=0．435,P=0．510);BC1组和BC2组术前AFP水平无明显差异,BC3组术前AFP明显高于BC1组和BC2组,BC3组患者术后复发率高达 67．9％,明显高于BC1组的33．3％和BC2组的22．2%,BC1组和Bc2组复发率未见明显差异。结论术前AFP水平>400 ng／ml的HCC肝移植患者术后复发率明显上升;术后AFP水平未能在 2个月内降至正常水平者复发率显著升高;移植后AFP的动态变化对预测HCC复发有重要价值。更多还原

【Abstract】 Objective To evaluate serum α-fetoprotein ( AFP) changes and tumor recurrence after liver transplantation ( LT) for hepatocellular carcinoma ( HCC) patients. Methods AFP levels of 67 patients with HCC before and after LT were analyzed retrospectively. According to the pre-LT AFP levels, patients were divided into three groups: group A (pre-LT AFP levels ≤20 ng/ml) , group B(20 ng/ml < pre-LT AFP levels ≤ 400 ng/ml) and group C( pre-LT AFP levels > 400 ng/ml). Patients in group B and group C after putting together were further divided into three sub-groups according to the decline extent of AFP, i. e. group BC1 ( post-LT AFP levels decreased to ≤20 ng/ml within 2 weeks) , group BC2 ( post-LT AFP levels decreased to ≤20 ng/ml within 2 months) and group BC3 (post-operation AFP levels did not decrease to ≤ 20 ng/ml within 2 months). Results All 67 patients were followed up for an average of 13. 2 months and the overall tumor recurrence and metastasis rate was 35. 8% (24/67). Recurrence was most often found in the lungs, the liver, bone marrow and lymph nodes. The recurrence rate in group C (52. 8% ) was higher than in group A and group B (group C vs. group A,x2=6. 759,P =0. 009;group C vs. group B,x2 =4. 550,P =0. 033) , the recurrence rate between group A and group B was not significantly different ( x2=0. 435 , P = 0. 510). The pre-LT AFP levels and post-LT tumor recurrence rate in group BC3 (67.9%) were higher than in group BC1 and group BC2. Conclusions post-LT HCC recurrence and metastasis was higher in patients with pre-LT AFP level > 400 ng/ml and in those the post-LT AFP level failed to decrease to ≤20 ng/ml within 2 months. The dynamic changes of AFP after LT were valuable in predicting post-transplant HCC recurrence.更多还原