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Does the preoperative alpha‐fetoprotein predict the recurrence and mortality after hepatectomy for hepatocellular carcinoma without macrovascular invasion in patients with normal liver function?
Author(s) -
Kudo Atsushi,
Matsumura Satoshi,
Ban Daisuke,
Irie Takumi,
Ochiai Takanori,
Tanaka Shinji,
Arii Shigeki,
Tanabe Minoru
Publication year - 2014
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/hepr.12335
Subject(s) - medicine , hepatocellular carcinoma , hepatectomy , gastroenterology , hazard ratio , alpha fetoprotein , risk factor , liver function , prothrombin time , multivariate analysis , carcinoma , surgery , confidence interval , resection
Aim It has been highly controversial whether elevated serum α‐fetoprotein ( AFP ) level before hepatectomy predicts recurrence and mortality of patients with hepatocellular carcinoma ( HCC ) or not. This study is to identify whether the index predicts recurrence and mortality after hepatectomy in HCC . Methods Of 568 consecutive patients, 342 with normal liver function ( C hild– P ugh score, 5) and no macrovascular invasion were enrolled between A pril 2000 and M arch 2013. Multivariate analysis was performed to identify risk factors for disease‐free survival ( DFS ) and overall survival ( OS ). Results In multivariate analysis, the elevated serum AFP level was an independent risk factor for DFS (hazard ratio [ HR ], 1.9; P < 0.0001) and OS ( HR , 2.0; P < 0.0001). Histological hepatic venous tumor thrombus was also an independent risk factor for DFS ( HR , 2.6; P < 0.0001) and OS ( HR , 2.5; P = 0.001). Anatomical resection decreases the risk factor for recurrence after hepatectomy ( HR , 0.6; P = 0.003), though it did not decrease the risk for OS ( P = 0.3). At 5 years, DFS rates were 42% and 21% ( P < 0.0001) and OS rates were 75% and 46% among patients with low and high AFP levels, respectively ( P < 0.0001). The area under the receiver–operator curves ( AUROC ) of serum AFP and des‐γ‐carboxy prothrombin were 0.65 and 0.58 for DFS and 0.65 and 0.57 for OS , respectively. Tumor size was the best predictor of microvascular invasion ( AUROC , 0.70, P < 0.0001). Conclusion Serum AFP was a highly reliable index for DFS and OS .