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摘要：
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摘要：目的 系统评价术前甲胎蛋白（alpha-fetoprotein，AFP）水平对肝细胞癌（hepatocellular
carcinoma，HCC）患者手术预后的影响。方法 通过计算机在PubMed、EMbase、Cochrane Library、
CBM、WanFang Data和CNKI数据库中检索关于术前AFP水平对HCC患者手术预后影响的随机对照试
验或前瞻性队列研究，检索时限均为从建库至2018年10月，由两位研究者独立筛选文献、提取资料，
并评价纳入研究的偏倚风险后，采用RevMan 5.3软件进行Meta分析。结果 共纳入5篇文献，总计2345
例患者，AFP阴性1046例，AFP阳性1299例，Meta分析结果显示AFP阴性组总生存率显著高于AFP阳性
组，差异有统计学意义（HR = 1.58，95%CI：1.24～2.02，I 2 = 72%，P = 0.0002），进一步亚组分析显示
AFP阴性组1年、3年和5年生存率均高于AFP阳性组，且随着时间延长，两组的差异增大（RR = 1.12，
95% CI：1.0～1.25，I 2 = 90%，P = 0.05；RR = 1.28，95%CI：1.13～1.45，I 2 = 63%，P ＜ 0.00001；RR =
1.31，95%CI：1.02～1.70，I 2 = 83%，P = 0.04）。共3篇文献提及无瘤生存率，采用随机效应模型，Meta
分析结果显示AFP阴性组无瘤生存率显著高于AFP阳性组，差异有统计学意义（HR = 1.62，95%CI：
1.26～2.10，I 2 = 64%，P = 0.0002）。结论 AFP阴性HCC患者手术预后较AFP阳性患者好，AFP可作
为HCC患者术后复查和随访的一个有效指标。
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Abstract: Objective To systematically evaluate the effects of preoperative alpha-fetoprotein (AFP) levels
on the prognosis of patients with hepatocellular carcinoma (HCC). Methods Databases including PubMed,
EMbase, Cochrane Library, CBM, WanFang Data and CNKI were electronically searched to collect randomized
controlled trials or prospective cohort studies about the effects of preoperative AFP levels on the surgical
prognosis of patients with HCC from inception to October 2018. Two reviewers independently screened
literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed by
RevMan 5.3 software. Results A total of 5 articles involving 2345 patients were included. There were 1046 AFP
negative cases and 1299 AFP positive cases. 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, I 2 = 72%, P = 0.0002), further subgroup analysis showed that 1-year, 3-year and 5-year
survival rates in AFP negative groups were higher than those in AFP positive group, and with the prolongation of
time, the greater the difference between the two groups (RR = 1.12, 95% CI: 1.0～1.25, I 2 = 90%, P = 0.05; RR =
1.28, 95%CI: 1.13～1.45, I 2 = 63%, P ＜ 0.00001; RR = 1.31, 95%CI: 1.02～1.70, I 2 = 83%, P = 0.04). Disease-
free survival rates were incorporated in three papers, according to fixed effects model, Meta-analysis showed
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, I 2 = 64%, P = 0.0002). Conclusion The
operation prognosis of HCC patients with AFP negative is better than that of AFP positive patients, AFP can be
used as an effective index for postoperative reexamination and follow-up of patients with HCC.
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