Abstract
BackgroundTotal tumor volume (TTV) and serum alfa fetoprotein (AFP) level are important risk factors linked with the high possibility of hepatocellular carcinoma (HCC) recurrence. The aim of the study was to evaluate the role of AFP/TTV ratio, as a prognostic marker, in the prediction of HCC recurrence after resection. MethodsPatients who underwent liver resection for HCC between 2010 and 2018 were retrospectively analyzed. Patients were divided into 2 groups; a group with AFP/TTV ≤2 and another group with AFP/TTV >2. Risk factors for HCC recurrence were recorded. ResultsA total of 286 HCC patients underwent liver resection (184 patients with AFP/TTV ≤ 2, and 102 patients with AFP/TTV > 2). There was a significant difference between the 2 groups in the preoperative total bilirubin level, serum AFP level, mean tumor diameter, TTV, operative blood loss, microvascular invasion and hospital stay (all P values < 0.05). The 1-, 3-, and 5-year tumor recurrence rates were 24.1%, 43%, and 57.6% respectively. The independent risk factors for tumor recurrence were AFP/TTV >2 (HR = 1.62, 95% CI = 1.29–1.98, P = 0.042), Macrovascular invasion (HR = 2.03, 95% CI = 2.17–2.38, P = 0.021, and microvascular invasion (HR = 1.36, 95% CI = 1.08–1.77, P = 0.019). ConclusionAFP/TTV ratio is a feasible prognostic marker for prediction of HCC recurrence after resection so, it can help in providing an intensive postoperative surveillance program to high risk patients for early detection and management of any recurrence.
Highlights
Surgical resection for hepatocellular carcinoma (HCC) is considered the most appropriate and curative treatment among the several therapeutic approaches in clinically resectable tumors
Total tumor volume (TTV) is another prognostic marker for tumor burden that can accurately predict the outcome by incorporation of the size and number of tumor nodules into one formula [7,8,9,10]
We retrospectively identified cirrhotic patients who had a liver resection for HCC in the period between January 2010 and January 2018 at the National Liver Institute, Menoufia University, Egypt
Summary
Surgical resection for hepatocellular carcinoma (HCC) is considered the most appropriate and curative treatment among the several therapeutic approaches in clinically resectable tumors. Different factors have been shown to have a significant risk for early or late HCC recurrence including the high preoperative level of alpha fetoprotein (AFP), multiple tumors, large tumor size, macrovascular or microvascular invasion, and type of liver resection. Identification of these patients with a high risk of tumor recurrence can help in providing an intensive surveillance program that may improve their survival [4,5,6]. Conclusion: AFP/TTV ratio is a feasible prognostic marker for prediction of HCC recurrence after resection so, it can help in providing an intensive postoperative surveillance program to high risk patients for early detection and management of any recurrence
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