甲胎蛋白-肿瘤负荷评分对肝细胞癌切除术后预后影响的多中心回顾性队列研究  

Alpha fetoprotein-tumor burden score predicts prognosis of patients with hepatocellular carcinoma after hepatectomy:a multicenter retrospective cohort study

作　　者：李梅霞[1] 覃莉[1] 邱占成 陈廷昊 谢飞[4] 余钰[5] 冷书生 齐维立 罗思源 吴友伟 胥月晴 李川[2,3] LI Meixia;QIN Li;QIU Zhancheng;CHEN Tinghao;XIE Fei;YU Yu;LENG Shusheng;QI Weili;LUO Siyuan;WU Youwei;XU Yueqing;LI Chuan(Division of Pancreatic Surgery,Department of General Surgery,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Division of Liver Surgery,Department of General Surgery,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Department of Hepatobiliary and Pancreatic Surgery,West China Ziyang Hospital/Ziyang Central Hospital,Ziyang,Sichuan 641399,P.R.China;Department of Hepatobiliary and Pancreatic Surgery,The First People’s Hospital of Neijiang,Neijiang,Sichuan 641000,P.R.China;Department of Hepatobiliary and Pancreatic Surgery,West China Yibin Hospital/The Second People’s Hospital of Yibin,Yibin,Sichuan 644002,P.R.China;Department of Hepatobiliary and Pancreatic Surgery,The Affiliated Hospital of Chengdu University,Chengdu 610081,P.R.China)

机构地区：[1]四川大学华西医院普外科,胰腺外科病房,成都610041 [2]四川大学华西医院普外科,肝脏外科病房,成都610041 [3]四川大学华西医院资阳医院/资阳市中心医院肝胆胰外科,四川资阳641399 [4]内江市第一人民医院肝胆胰外科,四川内江641000 [5]四川大学华西医院宜宾医院/宜宾市第二人民医院肝胆胰外科,四川宜宾644002 [6]成都大学附属医院肝胆胰外科,成都610081

出　　处：《中国普外基础与临床杂志》2025年第2期192-198,共7页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川省自然科学基金(项目编号:2024NSFSC0637)。

摘　　要：目的研究甲胎蛋白-肿瘤负荷评分(alpha fetoprotein-tumor burden score,ATS)对肝细胞癌(hepatocellular carcinoma,HCC)患者初次切除术后长期预后的影响。方法回顾性收集四川大学华西医院、内江市第一人民医院、成都大学附属医院、四川大学华西医院宜宾医院/宜宾市第二人民医院、四川大学华西医院资阳医院/资阳市中心医院2015–2022年间期间行初次肝切除的2907例HCC患者的临床资料。使用X-tile软件计算ATS评分的最佳截断值,采用Cox比例风险回归模型分别探索HCC患者术后无复发生存(recurrence-free survival,RFS)和总体生存(overall survival,OS)的危险因素。结果2907例患者均获访,随访时间1~90个月,中位随访时间为37个月。随访期间,复发1364例(46.9%,复发时间为术后1~89个月),死亡847例(29.1%,死亡时间为术后1~88个月)。随访患者的1、2、3年OS率分别为89.3%、81.4%、75.9%,1、2、3年RFS率分别为76.0%、64.3%、57.2%。低、中、高ATS评分HCC患者的5年RFS率分别为56.4%、45.0%和27.2%,低ATS评分患者的RFS优于高ATS评分患者(χ^(2)=264.747,P<0.001)。低、中、高ATS评分HCC患者的5年OS率分别为78.0%、59.8%和38.8%,低ATS评分患者的OS优于高ATS评分患者(χ^(2)=372.685,P<0.001)。多因素分析结果表明,控制其他因素后,中ATS评分[RR=1.375,95%CI(1.209,1.564),P<0.001]、高ATS评分[RR=2.048,95%CI(1.764,2.377),P<0.001]是术后RFS的危险因素;中ATS评分[RR=1.779,95%CI(1.499,2.112),P<0.001]、高ATS评分[RR=2.676,95%CI(2.211,3.239),P<0.001]也是影响术后OS的危险因素。结论ATS评分能够预测HCC患者初次切除术后的预后,高ATS评分的患者术后复发率更高,OS更短。Objective To study the effect of alpha fetoprotein-tumor burden score(ATS)on the long-term prognosis of hepatocellular carcinoma(HCC)after resection.Methods The data of 2907 patients with HCC who underwent first hepatectomy from West China Hospital of Sichuan University,West China Ziyang Hospital/Ziyang Central Hospital,The First People’s Hospital of Neijiang,West China Yibin Hospital/the Second People’s Hospital of Yibin,and the Affiliated Hospital of Chengdu University between 2015 and 2022,were retrospectively analyzed.The X-tile software was used to calculate the optimal truncation of the ATS score.Cox proportional hazard regression model was used to explore risk factors affecting postoperative recurrence-free survival(RFS)and overall survival(OS)in HCC patients,respectively.Results All patients were followed-up with a median of 37 months(1–90 months),1364 cases(46.9%,the recurrence time was 1–89 months after surgery)of them experienced recurrence and 847 cases(29.1%)died(the death time was 1–88 months after surgery).The 1-,2-and 3-year OS rates were 89.3%,81.4%and 75.9%,respectively.The 1-,2-and 3-year RFS rates were 76.0%,64.3%and 57.2%,respectively.The 5-year RFS rate of HCC patients with low-,medium-,and high-ATS scores were 56.4%,45.0%and 27.2%,respectively,and patients with low ATS score had better RFS(χ^(2)=264.747,P<0.001).The 5-year OS rates of HCC patients with low-,medium-,and high-ATS scores were 78.0%,59.8%and 38.8%,respectively,and patients with low-ATS score had better OS(χ^(2)=372.685,P<0.001).Multivariate Cox proportional hazard regression model suggested that,in condition of adjusting other factors,medium-ATS score[RR=1.375,95%CI(1.209,1.564),P<0.001]and high-ATS score[RR=2.048,95%CI(1.764,2.377),P<0.001]were risk factors for postoperative RFS;the medium-ATS score[RR=1.779,95%CI(1.499,2.112),P<0.001]and high ATS score[RR=2.676,95%CI(2.211,3.239),P<0.001]were also risk factors affecting postoperative OS.Conclusion ATS score can predict the prognosis of HCC patients after resection

关 键 词：肝细胞癌 甲胎蛋白-肿瘤负荷评分 肝切除 预后 

分 类 号：R735.7[医药卫生—肿瘤]