| Objectives:The study aims to explore the prognostic value and ability of AFP-L3 and DCP in AFP-negative HCC after hepatectomy,have a better judgment on the prognosis of patients with AFP-negative HCC,assist clinical decision-making,and maximize the survival time of patients.Methods:A total of 191 HCC patients with AFP<400ng/m L who were hospitalized for potential hepatectomy were recruited for the study voluntarily from March 2009 to May2018 at the First Hospital of Jilin University.Follow-up examinations were carried out3 months,6 months,and 1 year after hepatectomy and every year thereafter by specialized staff until death or the last scheduled follow-up.Information on general demographic and clinicopathological variables suspected to be risk factors for survival was collected for each patient.Blood samples were taken from all subjects on the morning before surgery after an overnight fast.Serum was separated and stored at-80°C.The magnetic microparticle chemiluminescence immunoassay method was used to measure the concentrations of AFP,AFP-L3 and DCP by a Hotgen MQ60 plus automatic immune analyzer.AFP-L3 was extracted by affinity adsorption centrifugation and expressed as the AFP-L3 percentage(AFP-L3%)of total AFP.Survival curves for overall survival(OS)and disease-free survival(DFS)were generated by the Kaplan–Meier method.The Cox regression model was used to calculate hazard ratios(HR)with their 95% confidence intervals(CI).Results:1.A total of 191 HCC patients with AFP<400ng/m L who were hospitalized for potential hepatectomy were recruited for the study.39(20.4%)subjects were AFP-L3%positive(≥10),60(31.4%)subjects were DCP positive(≥100 ng/ml),10(5.2%)subjects were both positive for AFP-L3% and DCP,and 102(53.4%)subjects were both negative.The median follow-up time was 61.23 months,and the 5-year OS rate was 50.4%.2.A total of 191 AFP-negative hepatocellular carcinoma was divided into two groups with AFP 200 ng/ml as the boundary.Log-rank test showed that OS and DFS between the two groups did not reach statistical differences(P>0.05).3.The results of OS multivariate Cox analysis showed that after adjustment for BMI,BCLC stage,Child grade,maximum tumor diameter and vascular invasion factors,compared with AFP-L3% negative patients,AFP-L3% positive patients had a91% increased risk of death [HR(95% CI): 1.91(1.12-3.25)].The risk of death for DCP positive patients was 1.73 times that of negative patients [HR(95% CI): 1.73(1.09-2.73)].The multivariate Cox analysis of DFS showed that after adjusting for BCLC stage,Child grade,maximum tumor diameter and vascular invasion factors,compared with AFP-L3% negative patients,AFP-L3% positive patients had a 73% increased risk of postoperative recurrence [HR(95% CI): 1.73(1.08-2.76)].The risk of postoperative recurrence of DCP positive patients is 1.83 times that of negative patients [HR(95%CI): 1.83(1.23-2.71)].4.Patients in the AFP-L3% and DCP double-positive group had a higher risk of death.The results of OS multivariate Cox analysis showed that after adjustment for BMI,BCLC stage,Child grade,maximum tumor diameter and vascular invasion factors,AFP-L3% positive or DCP positive was not found to be associated with OS.The risk of death in the both AFP-L3% and DCP positive group was 2.47 times that of the both negative group [HR(95% CI): 2.47(1.11-5.50)].The multivariate Cox analysis of DFS showed that after adjusting for BCLC stage,Child grade,maximum tumor diameter and vascular invasion factors,the AFP-L3%+DCP positive were not correlated with the prognosis of DFS.Combining AFP-L3% positive or DCP positive,the results of multivariate Cox analysis of OS and DFS showed that the correlation between one index positive and prognosis did not reach statistical significance.Conclusion:AFP-L3% positive,DCP positive were associated with OS and DFS in patients with AFP-negative HCC,and were independent risk factors for poor prognosis.The number of HCC duplex positive indicators was not found to be related to DFS,but was an independent prognostic factor of OS,the overall survival of AFP-L3% and DCP double-positive group was worse than double-negative group. |
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