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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

Insights

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.

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.
Abstract

Keywords:
alpha-fetoproteinhepatectomyhepatocellular carcinomaprognosis

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