Diagnostic and prognostic significance of α-fetoprotein in hepatocellular carcinoma

Abstract

Hepatocellular carcinoma (HCC) is an aggressive tumor with agrowing socioeconomic burden. International guidelines do not predominantly recommend the pretherapeutic determination of the alpha-fetoprotein (AFP) concentration. Regarding the prognostic value of AFP, the European study data are not sufficiently meaningful. This study aimed to demonstrate possible aspects of the AFP level and to investigate the prognostic value of AFP levels as well as to provide impetus for future prospective studies. At the time of data retrieval the prospective liver databank showed 1382 entries. All patients with ahistologically confirmed HCC were included resulting in 92final entries. For these patients, information on T, N, M and G stages, R status as well as sex, age and etiology of the HCC were available. For data analysis the patient population was divided into six groups based on three cut-off values. Furthermore, asurvival analysis was performed using Kaplan-Meier and amultifactorial analysis of the influencing factors regarding outcome. The AFP serum level showed a statistically significant correlation with the tumor diameter (T1/T2 vs. T3/T4) and grading (G1/G2 vs. G3/G4). The survival prognosis was significantly lower in patients with higher AFP values (p < 0.05). The median survival time for patients with AFP levels >8 μg/l was 35months, with AFP levels >200 μg/l or >400 μg/l showed areduced median survival of 15months and 11months, respectively. High AFP levels were a significant influencing factor for the outcome independent of the T stage, age and R status of patients in comparison to low AFP levels. Taking the present results into consideration, the AFP level can have a therapeutic usefulness. Therapeutic consequences could be derived from the height of the measured AFP concentration, with respect to the treatment strategy. Therefore, preoperative and postoperative determination of the AFP serum level is recommended in all HCC patients.