Correlation analysis of preoperative serum alpha-fetoprotein (AFP) level and prognosis of hepatocellular carcinoma (HCC) after hepatectomy

Wen-jun Ma, Hai-yong Wang, Li-song Teng, Wen-jun Ma, Hai-yong Wang, Li-song Teng

Abstract

Background: To investigate the prediction value of preoperative serum alpha-fetoprotein (AFP) level for the prognosis of hepatocellular carcinoma (HCC), by comparing pathological characteristics, recurrence rate and survival rate after hepatectomy.

Methods: 108 cases of HCC patients who received liver resection in our hospital from 2005 to 2011 were enrolled in this study. According to preoperative serum AFP level, the patients were divided into AFP ≤ 20 ng/mL group, AFP 20 to 400 ng/mL group and AFP > 400 ng/mL group, and the clinicopathological and cytopathological features were compared. All the patients were followed up for 24 months, the postoperative recurrence rates and survival rates were compared and analyzed, and the risk factors for HCC postoperative survival rate were studied by multifactor regression analysis.

Results: Of the 108 cases of HCC patients, there were 42 cases in AFP ≤20 ng/mL group, 28 cases in AFP 20-400 ng/mL group and 39 cases in AFP > 400 ng/mL group. It was shown that cell differentiation degrees (χ² = 20.198, P = 0.000) and microvascular invasion rates (χ² = 20.358, P = 0.000) were significantly different among the three groups. The AFP ≤ 20 ng/mL group showed higher cell differentiation degrees and significantly lower microvascular invasion rates compared to the other groups (P < 0.05). The follow-up data showed that postoperative 2-year recurrence rate (χ² = 6.164, P = 0.046), 18-month survival rate (χ² = 7.647, P = 0.022) and 24-month survival rate (χ² = 6.725, P = 0.035) of the three groups were significantly different, and we found that the AFP ≤ 20 ng/mL group had lower postoperative 2-year recurrence rate, and higher 18-month survival rate and 24-month survival rate than the other two groups (P <0.05). Multiple logistic regression analysis indicated that tumor diameter (≥ 5 cm) and preoperative serum AFP level (> 400 ng/mL) were closely correlated with HCC postoperative survival rate (P <0.05).

Conclusions: It is shown that preoperative serum AFP level has considerable predictive value for the malignant feature and prognosis of HCC. It is suggested that HCC patients with no contraindication of operation and serum AFP ≤ 20 ng/mL can benefit most from primary treatment of hepatectomy. While HCC patients with serum AFP higher than 20 ng/mL need comprehensive therapy besides surgical resection and close follow up.

Figures

Figure 1
Figure 1
Postoperative survival curve for three groups of patients with hepatocellular carcinoma. AFP, alpha-fetoprotein.

References

    1. Gao JD, Shao YF, Xu Y, Ming LH, Wu ZY, Liu GT, Wang XH, Gao WH, Sun YT, Feng XL, Liang LM, Zhang YH, Sun ZT. Tight association of hepatocellular carcinoma with HBV infection in North China. Hepatobiliary Pancreat Dis Int. 2005;11:46–49.
    1. Johnson PJ. Role of alpha-fetoprotein in the diagnosis and management of hepatocellular carcinoma. J Gastroenterol Hepatol. 1999;11:32–36. doi: 10.1046/j.1440-1746.1999.01814.x.
    1. Tateishi R, Yoshida H, Matsuyama Y, Mine N, Kondo Y, Omata M. Diagnostic accuracy of tumor markers for hepatocellular carcinoma: a systematic review. Hepatol Int. 2008;11:17–30. doi: 10.1007/s12072-007-9038-x.
    1. Snowberger N, Chinnakotla S, Lepe RM, Peattie J, Goldstein R, Klintmalm GB, Davis GL. Alpha fetoprotein, ultrasound, computerized tomography and magnetic resonance imaging for detection of hepatocellular carcinoma in patients with advanced cirrhosis. Aliment Pharmacol Ther. 2007;11:1187–1194. doi: 10.1111/j.1365-2036.2007.03498.x.
    1. Baig JA, Alam JM, Mahmood SR, Baig M, Shaheen R, Sultana I, Waheed A. Hepatocellular carcinoma (HCC) and diagnostic significance of A-fetoprotein (AFP) J Ayub Med Coll Abbottabad. 2009;11:72–75.
    1. Lee HY, Jung JH, Kang YS, Kim YS, Moon HS, Park KO, Lee YS, Kim SM, Seo SW, Lee SW, Kim SH, Lee BS, Kim NJ. Clinical significance of transiently elevated serum AFP level in developing hepatocellular carcinoma in HBsAg positive-liver cirrhosis [Article in Korean] Korean J Gastroenterol. 2004;11:252–259.
    1. Chang SK, Hlaing WW, Yu RQ, Lee TW, Ganpathi IS, Madhavan KK. Value of alpha-foetoprotein for screening of recurrence in hepatocellular carcinoma post resection. Singapore Med J. 2012;11:32–35.
    1. Tangkijvanich P, Anukulkarnkusol N, Suwangool P, Lertmaharit S, Hanvivatvong O, Kullavanijaya P, Poovorawan Y. Clinical characteristics and prognosis of hepatocellular carcinoma: analysis based on serum alpha-fetoprotein levels. J Clin Gastroenterol. 2000;11:302–308. doi: 10.1097/00004836-200012000-00007.
    1. Qin LX, Tang ZY. The prognostic significance of clinical and pathological features in hepatocellular carcinoma. World J Gastroenterol. 2002;11:193–199.
    1. Tong MJ, Hsien C, Song JJ, Kao JH, Sun HE, Hsu L, Han SH, Durazo FA, Saab S, Blatt LM. Factors associated with progression to hepatocellular carcinoma and to death from liver complications in patients with HBsAg-positive cirrhosis. Dig Dis Sci. 2009;11:1337–1346. doi: 10.1007/s10620-009-0747-y.
    1. Chan SL, Mo FK, Johnson PJ, Hui EP, Ma BB, Ho WM, Lam KC, Chan AT, Mok TS, Yeo W. New utility of an old marker: serial alpha-fetoprotein measurement in predicting radiologic response and survival of patients with hepatocellular carcinoma undergoing systemic chemotherapy. J Clin Oncol. 2009;11:446–452.
    1. Li P, Wang SS, Liu H, Li N, McNutt MA, Li G, Ding HG. Elevated serum alpha fetoprotein levels promote pathological progression of hepatocellular carcinoma. World J Gastroenterol. 2011;11:4563–4571. doi: 10.3748/wjg.v17.i41.4563.
    1. Zheng M, Ruan Y, Yang M, Guan Y, Wu Z. The comparative study on ultrastructure and immunohistochemistry in AFP negative and positive hepatocellular carcinoma. J Huazhong Univ Sci Technolog Med Sci. 2004;11:547–559. doi: 10.1007/BF02911350.
    1. Fan WZ, Yang JY, Lü MD. Transcatheter arterial chemoembolization plus percutaneous thermal ablation in large hepatocellular carcinoma: clinical observation of efficacy and predictors of prognostic factors [Article in Chinese] Zhonghua Yi Xue Za Zhi. 2011;11:2190–2194.
    1. Luo JT, Wei X, Zhou HY, Li Q. Influencing factors for intrahepatic distant recurrence of liver cancer after radiofrequency ablation [Article in Chinese] Zhonghua Wai Ke Za Zhi. 2009;11:1529–1531.
    1. Ikai I, Arii S, Kojiro M, Ichida T, Makuuchi M, Matsuyama Y, Nakanuma Y, Okita K, Omata M, Takayasu K, Yamaoka Y. Reevaluation of prognostic factors for survival after liver resection in patients with hepatocellular carcinoma in a Japanese nationwide survey. Cancer. 2004;11:796–802.
    1. Reichman TW, Bahramipour P, Barone A, Koneru B, Fisher A, Contractor D, Wilson D, Dela Torre A, Cho KC, Samanta A, Harrison LE. Hepatitis status, child-pugh classification, and serum AFP levels predict survival in patients treated with transarterial embolization for unresectable hepatocellular carcinoma. J Gastrointest Surg. 2005;11:638–645. doi: 10.1016/j.gassur.2004.11.002.
    1. Ha NB, Ha NB, Ahmed A, Ayoub W, Daugherty TJ, Chang ET, Lutchman GA, Garcia G, Cooper AD, Keeffe EB, Nguyen MH. Risk factors for hepatocellular carcinoma in patients with chronic liver disease: a case–control study. Cancer Causes Control. 2012;11:455–462. doi: 10.1007/s10552-012-9895-z.
    1. Levi DM, Tzakis AG, Martin P, Nishida S, Island E, Moon J, Selvaggi G, Tekin A, Madrazo BL, Narayanan G, Garcia MT, Feun LG, Tryphonopoulos P, Skartsis N, Livingstone AS. Liver transplantation for hepatocellular carcinoma in the model for end-stage liver disease era. J Am Coll Surg. 2010;11:727–734. doi: 10.1016/j.jamcollsurg.2010.01.007. 735–736.
    1. Kobayashi M, Hosaka T, Ikeda K, Seko Y, Kawamura Y, Sezaki H, Akuta N, Suzuki F, Suzuki Y, Saitoh S, Arase Y, Kumada H. Highly sensitive AFP-L3% assay is useful for predicting recurrence of hepatocellular carcinoma after curative treatment pre- and postoperatively. Hepatol Res. 2011;11:1036–1045. doi: 10.1111/j.1872-034X.2011.00858.x.
    1. Jiang J, Wu C, Shen Y, Xu B, Zheng X, Li X, Xu N. Clinical application of determining serum AFP-IgM complexes for diagnosis of small hepatocellular carcinoma. Anticancer Res. 2011;11:687–691.
    1. Xu WF, Fei YM, Zhou JK, Shen HJ, Chen XF, Lv QQ, Ding YY. Significance of serum golgi protein 73 (GP73), alpha-fetoprotein (AFP) and lectin-reactive alpha-fetoprotein (AFP-L3) expresssion in primary hepatic carcinoma [Article in Chinese] Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi. 2011;11:286–288.
    1. Volk ML, Hernandez JC, Su GL, Lok AS, Marrero JA. Risk factors for hepatocellular carcinoma may impair the performance of biomarkers: a comparison of AFP, DCP, and AFP-L3. Cancer Biomark. 2007;11:79–87.
    1. Yamamoto K, Imamura H, Matsuyama Y, Kume Y, Ikeda H, Norman GL, Shums Z, Aoki T, Hasegawa K, Beck Y, Sugawara Y, Kokudo N. AFP, AFP-L3, DCP, and GP73 as markers for monitoring treatment response and recurrence and as surrogate markers of clinicopathological variables of HCC. Gastroenterol. 2010;11:1272–1282. doi: 10.1007/s00535-010-0278-5.

Source: PubMed

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