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[目的]探讨肝细胞癌患者的外周血中甲胎蛋白(AFP)mRNA的检测在肝癌术后预后中的应用价值。[方法]应用巢式PCR和TaqMan MGB探针法定量PCR技术,检测105例肝细胞癌患者和30例健康志愿者外周血AFP mRNA的表达情况。[结果]肝细胞癌患者术前外周血AFP mRNA的阳性率43.8%(46/105)高于健康对照10.0%(3/30),有显著性差异(P< 0.001)。术前血中AFP mRNA的表达与各项肿瘤侵袭性指标显著相关,包括肿瘤数目、大小、有无肉眼及镜下血管侵犯。AFP mRNA阴性患者1、2、3年生存率以及1、2、3年无瘤生存率均显著比AFP mRNA阳性患者术后高(两者均P=0.004)。多因素分析也指出术前外周血中是否表达AFP mRNA是预测术后复发的独立因素。[结论]肝癌患者术前外周血中是否表达AFP mRNA与肿瘤侵袭性相关,对于预测术后复发具有重要价值。
[Objective] To investigate the value of detection of AFP mRNA in the peripheral blood of patients with hepatocellular carcinoma (HCC) in prognosis of liver cancer. [Method] The expression of AFP mRNA in peripheral blood of 105 patients with hepatocellular carcinoma and 30 healthy volunteers was detected by nested PCR and TaqMan MGB probe quantitative PCR. [Results] The positive rate of AFP mRNA in preoperative peripheral blood of HCC patients was 43.8% (46/105), which was significantly higher than that of healthy controls (10.0%, 3/30) (P <0.001). Preoperative blood AFP mRNA expression was significantly associated with various tumor invasiveness indicators, including the number of tumors, size, with or without macroscopic and vascular invasion. The 1-, 2-, 3-, and 1-year, 2-year, 3-year disease-free survival rates were significantly higher in AFP mRNA-negative patients than in AFP mRNA-positive patients (both P = 0.004). Multivariate analysis also pointed out whether preoperative expression of AFP mRNA in peripheral blood is an independent predictor of postoperative recurrence. [Conclusion] Whether AFP mRNA is expressed preoperatively in patients with hepatocellular carcinoma is related to tumor invasiveness, which is of great value in predicting postoperative recurrence.