甲種胎兒蛋白與肝細胞癌

Alpha-Fetoprotein and Hepatocellular Carcinoma

血清甲種胎兒蛋白在偵測及診斷肝細胞癌之地位已經確定，但其在肝細胞癌手術切除後患者長期追蹤上之角色尚乏報告。我們連續收集經病理證實之400位肝細胞癌病例加以分析。其中血清甲種胎兒蛋白值正常者有103位，腫瘤小於5公分者及血清B型肝炎表面抗原陰性者之數值較易在正常範圍內。接受肝細胞癌切除手術者共有106位，追縱期間復發者有44位。肝細胞癌切除前血清甲種胎兒蛋白值之是否異常升高，與其復發時之血清甲種胎兒蛋白值有密切關聯。術後之追蹤過程中，血清甲種胎兒蛋白之測定與腹部超音波掃瞄術對於肝細胞癌復發之偵測互有優劣。若肝細跑癌成功切除後，患者之血清甲種胎兒蛋白值未能降至正常範圍內，在其術後追縱過程中皆可再發現新的肝細胞癌。有4位肝細胞癌患者之肝內腫瘤是在其血清甲種胎兒蛋白明顯上升(>400 ng/ml)2〜3年後才被偵測出來。因此，血清甲種胎兒蛋白之測定在肝細胞癌患者術後之追蹤上有其價值，但其應用需與腹部超音波掃瞄術相輔相成方能彌補其不足。只要血清甲種胎兒蛋白值異常升高，務必長期定期追縱，才能分辨其意義，且能早期發現肝細胞癌。

The role of serum α-fetoprotein (AFP) in the detection and diagnosis of hepatocellular carcinoma (HCC) has been established. Its value in the long-term follow-up of patients with HCC resected has rarely been reported, Four hundred consecutive patients with pathologically proven HCC were recruited for this study, and 103 of them had persistently normal levels of serum AFP. Serum AFP levels tended to be normal in HCC patients with tumor size <5 cm in its diameter and patients who were seronegative for hepatitis B surface antigen. Totally 106 patients received the resection of HCC, and 44 of them had the tumor recurrence during a long-term follow-up. Whether serum AFP levels were abnormally high at the recurrence of HCC were closely related to serum AFP levels before HCC resection. During the postoperative follow-up, measurement of serm AFP values was superior to ultrasonography in the detection of recurred HCC in some patients, and vice versa. If serum levels of AFP did not return to normal after the resection of HCC was performed, other HCCs could be detected a few months later. In our series, HCC was detected 2~3 years after serum levels of AFP remarkably elevated (>400 ng/ml) in four patients, it is concluded that the value of serum AFP level in long-term postoperative follow-up of patients with HCC is confirmed, However, the measurements of serum AFP level should be applied in combination with abdominal ultrasonography to compensate the lower sensitivity of AFP in some cases. Four patients with elevated serum AFP levels, regular long-term follow-up is needed to clarify the significance and early detect HCC if any.