Guidelines vary on alpha-fetoprotein (AFP) testing for hepatocellular carcinoma (HCC) screening. This study aims to reassess AFP’s role in HCC surveillance, utilizing a comprehensive, recent, nationwide cohort. Utilizing the National Health Claims Database from the Korean National Health Insurance Service, this research included data from 185,316 HCC patients registered between 2008 and 2018. Specifically, 81,520 patients diagnosed with HCC from 2008 to 2014 were analyzed. The study focused primarily on mortality and, secondarily, on the status of curative treatments. Multivariate analysis revealed that frequent AFP testing significantly impacts overall survival in HCC patients. Specifically, each additional AFP test correlated with a 6% relative improvement in survival (hazard ratio = 0.94, 95% CI: 0.940–0.947,p< 0.001). Patients who underwent AFP testing three or more times within two years prior to HCC diagnosis showed improved survival rates, with 55.6% receiving liver transplantation or hepatectomy. This trend was particularly pronounced in hepatitis B patients undergoing antiviral treatment. The findings highlight the potential of regular AFP testing to enhance survival in HCC patients, especially those with hepatitis B. Integrating frequent AFP testing with ultrasonography could increase the likelihood of early detection and access to curative treatments.
关于肝细胞癌筛查中甲胎蛋白检测的临床应用指南存在差异。本研究旨在利用近期全国性大规模队列数据，重新评估甲胎蛋白在肝细胞癌监测中的作用。研究基于韩国国民健康保险公团的全国健康保险理赔数据库，纳入2008年至2018年间登记的185,316例肝细胞癌患者数据，其中重点分析了2008-2014年间确诊的81,520例患者。研究主要关注患者死亡率，次要观察指标为根治性治疗实施情况。多变量分析显示，频繁进行甲胎蛋白检测对肝细胞癌患者总生存期具有显著影响。具体而言，每增加一次甲胎蛋白检测与生存率相对提高6%相关（风险比=0.94，95%置信区间：0.940-0.947，p<0.001）。在肝细胞癌诊断前两年内接受三次及以上甲胎蛋白检测的患者生存率显著改善，其中55.6%接受了肝移植或肝切除术。这一趋势在接受抗病毒治疗的乙型肝炎患者中尤为明显。研究结果凸显了定期甲胎蛋白检测对提高肝细胞癌患者生存率的潜在价值，特别是对乙型肝炎患者。将高频次甲胎蛋白检测与超声检查相结合，可提高早期发现机会并增加获得根治性治疗的可能性。
肿瘤(癌症)患者之家