Prediction of tumor recurrence by α-fetoprotein model after curative resection for hepatocellular carcinoma. (March 2021)

• Record Type: Journal Article
• Authors: Ding, Hong-Fan; Zhang, Xu-Feng; Bagante, Fabio; Ratti, Francesca; Marques, Hugo P.; Soubrane, Olivier; Lam, Vincent; Poultsides, George A.; Popescu, Irinel; Alexandrescu, Sorin; Martel, Guillaume; Workneh, Aklile; Guglielmi, Alfredo; Hugh, Tom; Aldrighetti, Luca; Lv, Yi; Pawlik, Timothy M.
• Is Part Of: European journal of surgical oncology. Volume 47:Supplement Part B (2021)
• Page Start: 660
• Page End: 666
• Publication Date: 2021-03
• Subjects: Hepatocellular carcinoma -- Barcelona clinic liver cancer -- Surgery -- Alpha-fetoprotein; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2020.10.017
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Background: Preoperative α-fetoprotein (AFP) level levels may help select patients with hepatocellular carcinoma (HCC) for surgery. The objective of the current study was to assess an AFP model to predict tumor recurrence and patient survival after curative resection for HCC. Methods: Patients undergoing curative-intent resection for HCC between 2000 and 2017 were identified from a multi-institutional database. AFP score was calculated based on the last evaluation before surgery. Probabilities of tumor recurrence and overall survival (OS) were compared according to an AFP model. Results: A total of 825 patients were included. An optimal cut-off AFP score of 2 was identified with an AFP score ≥3 versus ≤2 independently predicting tumor recurrence and OS. Net reclassification improvements indicated the AFP model was superior to the Barcelona Clinic Liver Cancer (BCLC) system to predict recurrence ( p < 0.001). Among patients with BCLC B–C, AFP score ≤2 identified a subgroup of patients with AFP levels of ≤100 ng/mL with a low 5-year recurrence risk (≤2 45.2% vs. ≥3 61.8%, p = 0.046) and favorable 5-year OS (≤2 54.5% vs. ≥3 39.4%, p = 0.035). In contrast, among patients within BCLC 0-A, AFP score ≥3 identified a subgroup of patients with AFP values > 1000 ng/mL with a high 5-year recurrence (≥3 47.9% vs. ≤2% 38.4%, p = 0.046) and worse 5-year OS (≥3 47.8% vs. ≤2 65.9%, p < 0.001). In addition, the AFP score independently correlated with vascular invasion, tumor differentiation and capsule invasion. Conclusions: The AFP model was more accurate than the BCLC system to identify which HCC patients may benefit the most from surgical resection. Highlights: The AFP score ≥3 versus ≤2 independently predicted tumor recurrence and overall survival (OS). A high AFP model score ≥3 was strongly correlated with adverse tumor features and behavior, and, in turn, was able to discriminated patients with low versus high risk of recurrence and death. The AFP model performed better than the BCLC staging as use of the model was able to differentiate patients with BCLC stage 0-A who did poorly after surgery, as well as identify a subgroup of patients with BCLC B–C who actually fared well after resection.