Abstract
BackgroundAlthough many studies have confirmed the prognostic value of preoperative alpha-fetoprotein (AFP) in patients with hepatocellular carcinoma (HCC), the association between AFP at baseline (b-AFP), subsequent AFP at relapse (r-AFP), and AFP alteration and overall survival in HCC patients receiving locoregional therapy has rarely been systematically elucidated.Patients and MethodsA total of 583 subjects with newly diagnosis of virus-related HCC who were admitted to Beijing You ‘an Hospital, Capital Medical University from January 1, 2012 to December 31, 2016 were prospectively enrolled. The influence of b-AFP, subsequent r-AFP, and AFP alteration on relapse and post-recurrence survival were analyzed.ResultsBy the end of follow-up, a total of 431 (73.9%) patients relapsed and 200 (34.3%) died. Patients with positive b-AFP had a 24% increased risk of recurrence compared with those who were negative. Patients with positive r-AFP had a 68% increased risk of death after relapse compared with those who were negative. The cumulative recurrence-death survival (RDS) rates for 1, 3, 5 years in patients with negative r-AFP were 85.6% (184/215), 70.2%(151/215), and 67.4%(145/215), while the corresponding rates were 75.1% (154/205), 51.2% (105/205), and 48.8% (100/205) in those with positive AFP (P<0.001). 35 (21.6%) of the 162 patients with negative b-AFP turned positive at the time of recurrence, and of this subset, only 12 (34.3%) survived. Of the 255 patients with positive b-AFP, 86 (33.7%) turned negative at the time of relapse, and of this subset, only 30 (34.9%) died. The 1-, 3-, and 5-year cumulative RDS rates were also compared among groups stratified by AFP at baseline and relapse. The present study found that patients with positive AFP at baseline and relapse, as well as those who were negative turned positive, had the shortest RDS and OS.ConclusionsNot only AFP at baseline but also subsequent AFP at relapse can be used to predict a post-recurrence survival, which can help evaluate mortality risk stratification of patients after relapse.
Highlights
Hepatocellular carcinoma (HCC) ranks sixth in morbidity and third in mortality with a rapidly rising trend in the world, making it one of the most common malignancies [1]
Alpha fetoprotein (AFP) as a specific tumor marker plays an important role in the diagnosis of HCC, and be used to assess tumor burden, which is why it is used to predict prognosis in patients with HCC after various treatments [4, 5]
500 (85.5%), 58 (9.9%), and 25 (4.3%) of HCC were associated with HBV, HCV, and co-infection, respectively
Summary
Hepatocellular carcinoma (HCC) ranks sixth in morbidity and third in mortality with a rapidly rising trend in the world, making it one of the most common malignancies [1]. Alpha fetoprotein (AFP) as a specific tumor marker plays an important role in the diagnosis of HCC, and be used to assess tumor burden, which is why it is used to predict prognosis in patients with HCC after various treatments [4, 5]. Some studies have demonstrated that AFP included can improve the predictive efficacy of prognostic scoring systems for HCC [6, 7]. Many studies have confirmed the prognostic value of preoperative alpha-fetoprotein (AFP) in patients with hepatocellular carcinoma (HCC), the association between AFP at baseline (b-AFP), subsequent AFP at relapse (r-AFP), and AFP alteration and overall survival in HCC patients receiving locoregional therapy has rarely been systematically elucidated
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