Abstract
BackgroundSerum lens culinaris agglutinin-reactive fraction of α-fetoprotein (AFP-L3%) has been widely used for HCC diagnosis and follow-up surveillance as tumor serologic marker. However, the prognostic value of high pre-treatment serum AFP-L3% in patients with hepatocellular carcinoma (HCC) remains controversial. We therefore conduct a meta-analysis to assess the relationship between high pre-treatment serum AFP-L3% and clinical outcome of HCC.MethodsEligible studies were identified through systematic literature searches. A meta-analysis of fifteen studies (4,465 patients) was carried out to evaluate the association between high pre-treatment serum AFP-L3% and overall survival (OS) and disease-free survival (DFS) in HCC patients. Sensitivity and subgroup analyses were also conducted in this meta-analysis.Results Our analysis results showed that high pre-treatment serum AFP-L3% implied poor OS (HR: 1.65, 95%CI: 1.45–1.89 p<0.00001) and DFS (HR: 1.80, 95% CI: 1.49–2.17 p<0.00001) of HCC. Subgroup analysis revealed that there was association between pre-treatment serum AFP-L3% and endpoint (OS and DFS) in low AFP concentration HCC patients (HR: 1.96, 95% CI: 1.24–3.10, p = 0.004; HR: 2.53, 95% CI: 1.09–5.89, p = 0.03, respectively).ConclusionThe current evidence suggests that high pre-treatment serum AFP-L3% levels indicated a poor prognosis for patients with HCC and AFP-L3% may have significant prognostic value in HCC patients with low AFP concentration.
Highlights
Hepatocellular carcinoma (HCC) is one of the most frequent neoplasms worldwide, the fifth most prevalent malignancy and the third common cause of cancer-related deaths in the world [1]
While incidence rates are declining for most cancer sites, hepatocellular carcinoma (HCC) is increasing among both men and women [1]
For the study that only provided the detailed data about radiofrequency ablation (RFA) on overall survival (OS) and disease-free survival (DFS) we used only the relevant information in our meta-analysis [19]
Summary
Hepatocellular carcinoma (HCC) is one of the most frequent neoplasms worldwide, the fifth most prevalent malignancy and the third common cause of cancer-related deaths in the world [1]. Despite of the significant advances in surgical techniques, anesthesia and medical care, better perioperative managements, and new antineoplastic drugs for clinical use, the overall survival of HCC patients remains dismal due to a high rate of recurrence or intrahepatic metastasis after effective treatments [2]. The only generally available serologic marker for HCC surveillance, diagnosis, and monitoring is serum a-fetoprotein (AFP). The combination of ultrasonography (US) and AFP is commonly used for surveillance of HCC. Serum lens culinaris agglutinin-reactive fraction of a-fetoprotein (AFP-L3%) has been widely used for HCC diagnosis and follow-up surveillance as tumor serologic marker. The prognostic value of high pre-treatment serum AFP-L3% in patients with hepatocellular carcinoma (HCC) remains controversial. We conduct a meta-analysis to assess the relationship between high pre-treatment serum AFP-L3% and clinical outcome of HCC
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