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Research Paper|Volume 11, Issue 23|pp 11111—11123

Daily decrease of post-operative alpha-fetoprotein by 9% discriminates prognosis of HCC: A multicenter retrospective study

Pei-Yun Zhou1, Chao-Ping Yang2, Zheng Tang1, Yong Yi1, Wei-Ren Liu1, Meng-Xin Tian1, Jin-Long Huang1, Wei Gan1, Xi-Fei Jiang1, Gao Liu1, Han Wang1, Chen-Yang Tao1, Yuan Fang1, Wei-Feng Qu1, Cheng Zhou1, Ruo-Yu Guan1, Bao-Ye Sun1, Yu-Fu Zhou1, Shu-Shu Song1, Zhen-Bin Ding1, Yuan-Fei Peng1, Zhi Dai1, Jian Zhou1,3, Jia Fan1,3, Guo-Zhong Gong2, Ying-Hong Shi1, Shuang-Jian Qiu1
  • 1Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai, China
  • 2Department of Infectious Diseases, Institute of Hepatology, The Second Xiangya Hospital, Central South University, Changsha, China
  • 3Institutes of Biomedical Sciences, Fudan University, Shanghai, People's Republic of China
* Equal contribution
Received: August 25, 2019Accepted: November 18, 2019Published: December 12, 2019
https://doi.org/10.18632/aging.102513

Copyright © 2019 Zhou et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Background: Mixed evidence challenges preoperative alpha-fetoprotein (AFP) as an independent prognostic factor for patients with hepatocellular carcinoma (HCC) after hepatectomy.

Results: Daily post-operative decrease of AFP by 9% as compared to the preoperative level (A09) were selected as the Cut-off. The Kaplan-Meier curve showed that A09 was significantly different for OS (P=0.043) and RFS (P=0.03). A decrease in risk by 54% was observed for OS and 32% for RFS in the at-risk population (A09>9%). A better concordance was observed after adding A09 into TNM and BCLC staging systems. Moreover, a consistent concordance was observed in the internal (FDZS5:0.63; FDZS3:0.608) and external (FDZS5:0.85; FDZS3:0.762) validation cohorts, suggesting its prognostic value in HCC population with elevated AFP.

Conclusions: Decrease in perioperative serum AFP rather than preoperative AFP is an independent prognostic factor for HCC patients after hepatectomy. Cut-off A09 significantly discriminates overall and recurrence-free survival and could be interpret into TNM and BCLC staging systems to improve the stratification power for HCC patients with elevated AFP.

Methods: Kaplan-Meier curve depicted the differences of overall survival (OS) and recurrence-free survival (RFS). Nomogram and concordance were employed to evaluate the superiority of the current staging system.