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Related Concept Videos

Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test01:22

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In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess...
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Laparoscopic Anterior Right Hepatectomy: A Single-Center Experience
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Daily decrease of post-operative alpha-fetoprotein by 9% discriminates prognosis of HCC: A multicenter retrospective

Pei-Yun Zhou1, Chao-Ping Yang2, Zheng Tang1

  • 1Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai, China.

Aging
|December 13, 2019
PubMed
Summary

Post-operative decrease in alpha-fetoprotein (AFP) levels, not preoperative levels, is a significant predictor of outcomes for hepatocellular carcinoma (HCC) patients undergoing hepatectomy. A 9% daily decrease (A09) improves survival predictions and staging systems.

Keywords:
alpha-fetoproteinhepatectomyhepatocellular carcinomaprognosis

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Area of Science:

  • Hepatobiliary Surgery
  • Oncology
  • Biomarker Research

Background:

  • Preoperative alpha-fetoprotein (AFP) has shown mixed results as an independent prognostic factor in hepatocellular carcinoma (HCC) patients post-hepatectomy.
  • Accurate prognostic markers are crucial for optimizing treatment strategies and patient outcomes in HCC.

Purpose of the Study:

  • To investigate the prognostic value of perioperative serum AFP dynamics in HCC patients after hepatectomy.
  • To determine if a specific threshold of AFP decrease can serve as an independent prognostic indicator.

Main Methods:

  • Kaplan-Meier survival analysis was used to assess overall survival (OS) and recurrence-free survival (RFS).
  • A 9% daily post-operative decrease in AFP (A09) was established as the cutoff value.
  • Concordance indices were calculated to evaluate the integration of A09 into existing TNM and BCLC staging systems, using internal and external validation cohorts.

Main Results:

  • A daily post-operative AFP decrease of 9% (A09) significantly differentiated OS (P=0.043) and RFS (P=0.03).
  • Patients with A09 > 9% had a 54% reduced risk of mortality and a 32% reduced risk of recurrence.
  • Integrating A09 into TNM and BCLC staging systems improved prognostic stratification accuracy, confirmed by consistent concordance in validation cohorts.

Conclusions:

  • Perioperative serum AFP decrease, specifically the A09 cutoff, is a more reliable independent prognostic factor than preoperative AFP for HCC patients post-hepatectomy.
  • The A09 cutoff enhances the predictive power of current staging systems (TNM, BCLC) for HCC patients with elevated AFP.