Analysis Of The Clinical Distribution Of AFP And Risk Factors For Surgical Prognosis In Hepatocellular Carcinoma

Part? Analysis of the clinical distribution of AFP and risk factors for surgical prognosis in hepatocellular carcinomaObjective: As one of the most common tumors in the world,liver cancer has a high degree of malignancy,limited treatment and poor prognosis.It ranks the third place in the global cancer-related mortality and seriously endangers human health.Alpha fetoprotein is a glycoprotein that is present in high concentrations during the embryonic period,especially at week 13.Physiology of human body to the low level of AFP,after the liver cell cancer,cancer cells can regain the ability of synthesis of AFP,due to excessive expression of AFP in most liver cancer cells,the diagnosis of liver cancer has become the most common tumor markers,this study of ningxia medical university general hospital treated 339 cases(110 cases)surgery in patients with liver cancer clinical and follow-up data were analyzed retrospectively,discuss the preoperative clinical distribution characteristics of AFP,comparing AFP positive and negative surgery for HCC prognosis and risk factors analysis of the prognosis of surgery.Method: Relevant data were queried through the electronic medical record system of the general hospital of ningxia medical university,and liver cancer patients were divided into positive group and negative group according to the AFP level(the reference value range was 0-20 ng/ml).Through the analysis of age,gender,nationality,history of chronic hepatitis,aspartate aminotransferase(AST),alanine aminotransferase(ALT),gamma pancreatic acyl transferase(GGT),total bilirubin(TBIL),albumin(propagated),clotting time(PT),platelet(PLT),Child stage,tumor size,tumor number,operation related(operation time,intraoperative blood loss,intraoperative blood transfusion volume)and to evaluate the clinical distribution of AFP,differentiated the Kaplan-Meier to survival analysis of two groups of patients with surgery,Cox proportional risk model for multivariate analysis.Result: A total of 339 HCC patients were included,among which 123 were AFP negative,accounting for 36.28%,and 216 were AFP positive,accounting for 63.72%.The results showed that there were statistically significant differences in hepatitis history,AST,TBIL and PT between the two groups(P < 0.05).Among the 110 HCC patients who underwent surgery,58 of them were AFP negative,accounting for 52.73%,and 52 of them were AFP positive,accounting for 47.27%.The results showed that there were statistically significant differences in operation time and differentiation between the two groups(P < 0.05).AFP negative groups of 1,3,5 years after the total survival rate are 93.04%,72.87% and 51.33% respectively,the AFP positive group distribution of overall survival was 82.56%,43.68%,27.66%,the difference between the two groups statistically significant(p = 0.004 < 0.05),the AFP negative groups 1,3,5 years after the disease-free survival rates were 82.69%,49.32%,34.83%,AFP positive group distribution of disease-free survival rate was 63.25%,32.04%,18.89%,There were statistically significant differences between the two groups(p=0.017 < 0.05).Kaplan-Meier single factor analysis showed that there is no history of chronic hepatitis,preoperative AFP level(> 20 ng/ml),GGT level and grade of the Child,tumor size,tumor number and differentiation is a major risk factor for HCC postoperative survival,Cox multi-factor analysis showed that the AFP levels,Child stage,tumor size and differentiation degree,are independent risk factors affect the prognosis of HCC patients.For patients with postoperative recurrence of single factor analysis showed that: the history of chronic hepatitis,the AFP levels(> 20 ng/ml),GGT level,Child stage,tumor size and differentiation degree,is a major risk factor for recurrence of HCC patients,Cox multi-factor analysis showed that the AFP level and grade of the Child and the degree of differentiation of the independent risk factors influencing the postoperative recurrence of HCC patients.Conclusion: AFP negative occurs in patients with no history of chronic hepatitis,liver function is good,and AFP negative patients' overall survival and disease-free survival rates were higher than in AFP positive patients,the prognosis is good.Child grade,tumor size and differentiation degree of HCC patients with postoperative survival time and the independent risk factors of recurrence.Part ? Comparison of surgical outcomes between afp-positive and afp-negative liver cancer patients: A Meta-analysisObjective: As one of the most common malignant tumors,liver cancer has a poor prognosis and limited treatment.It is the third leading cause of cancer-related death in humans and seriously endangers human health.Currently,the main treatment methods for liver cancer are surgical resection,local chemoembolization(TACE),radiofrequency ablation(RF),liver transplantation and molecular immunotherapy,but the effect is not good,and there is a lack of a reliable prognostic index.AFP due to excessive expression in most of the liver cancer cells,became the most common tumor markers in the diagnosis of HCC,with the understanding of AFP,more and more clinical workers will be AFP as HCC prognosis evaluation index,and the international guidelines that are attached to the HCC monitoring,in this study was to compare the AFP negative and positive HCC patients disease-free and overall survival,1,3,5 years survival rate and study the effects of preoperative AFP level on the prognosis of HCC,provides reference for clinical doctors to make the best decisions.Methods: Databases including PubMed,EMbase,Cochrane Library,CBM,Wang Fang Data and CNKI were electronically searched to collect randomized controlled trials or prospective cohort study about the effect of preoperative AFP level on the surgical prognosis of HCC patients from inception to October 2018.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies.Then,meta-analysis was performed using Rev Man 5.3 software.Results: A total of 6 articles involving 2345 patients were included.The results of meta-analysis showed that the overall survival of AFP negative group was obviously higher than that of AFP positive group,the difference was statistically significant [HR=1.58,95%CI(1.24,2.02),I2=72%,P=0.0002],further subgroup analysis showed that the AFP negative groups 1,3,5 year overall survival rates were higher than in AFP positive group,and with growth time,the greater the difference of the two groups,the difference was statistically significant [RR = 1.11,95% CI(1.02,1.21),I2 = 87%,P = 0.02],[RR = 1.28,95% CI(1.16,1.41),I2 = 55%,P < 0.00001],[RR = 1.33,95% CI(1.09,1.62),I2 = 0%,P =0.006).Disease-free survival rates were incorporated into 2 paper,by using the fixed effects model,Meta-analysis results show that the disease-free survival of AFP negative group was obviously higher than that of AFP positive group,the difference was statistically significant[HR=1.62,95%CI(1.26,2.10),I2=64%,P=0.0002].Conclusion: the operation prognosis of AFP negative HCC patients is better than that of AFP positive patients.