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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。
Objective To investigate the relationship between the serum level of α-fetoprotein (AFP) and the recurrence of hepatocellular carcinoma after liver transplantation in patients with hepatocellular carcinoma (HCC). Methods A retrospective analysis of 67 patients with HCC in our hospital before and after liver transplantation AFP dynamic changes and the recurrence of liver cancer. According to serum AFP level before liver transplantation, the patients were divided into three groups: group A (preoperative serum AFP≤20 ng / ml), group B (20 ng / ml preoperative serum AFP≤400 ng / ml) and According to the decrease of postoperative AFP, patients in group B and C were divided into three subgroups: the serum AFP was reduced to ≤20 ng / ml within 2 weeks after operation in group C (preoperative serum AFP> 400 ng / ml) ml (BCI group) to ≤20 ng / ml (BC2 group) within 2 to 2 months after operation and not to ≤20 ng / ml within 2 months (BC3 group). Results The average follow-up time of 67 cases of HCC after transplantation was 13.2 months. The overall recurrence rate was 35.8% (24/67). The average recurrence time was (7.2 ± 0.7) months. The common The recurrence and metastasis were lung, liver, bone and lymph node in turn. The recurrence rate of group C was 52.8% after transplantation, which was significantly higher than that of group A and B (group C, group A, x2 = 6.759, P = 0.009; group C than group B, x2 = 4.550, P = 0.033). There was no significant difference in recurrence rates between groups A and B (x2 = 0.435, P = 0.510) There was no significant difference in preoperative AFP levels between BC3 group and preoperative BC3 group, BC1 group and BC2 group. The recurrence rate of BC3 group was 67.9%, significantly higher than that of BC1 group (33.3%) and BC2 group Group 22.2%, BC1 group and Bc2 group recurrence rate no significant difference. Conclusions The postoperative recurrence rate of HCC liver transplantation patients with AFP level> 400 ng / ml preoperatively increased significantly. The recurrence rate of postoperative AFP levels was not increased to normal level within 2 months. The dynamic changes of AFP after transplantation Predict the recurrence of HCC has important value.