Objective: To explore the correlation between alpha fetoprotein (AFP) and the prognosis of hepatocellular carcinoma after hepatectomy in an ethnic Chinese population.
Methods: This study retrospectively analyzed the surgical outcomes of hepatocellular carcinoma (HCC) in 779 patients undergoing hepatic resection between June 1999 and March 2010 at our hospital. The postoperative prognostic factors were assessed by univariate Kaplan-Meier analysis and a multivariate Cox proportional hazard model.
Results: The cut-off value of AFP was 18.98 µg/L by receiver operating characteristic (ROC) curve statistics and the sensitivity and specificity rates were 54.6% and 82.0% respectively. The overall survival (OS) rate of AFP negative group (AFP < 20 µg/L) for 1, 3 and 5-year was 94.4%, 77.3% and 58.9% while the OS rate of AFP positive group (AFP ≥ 20 µg/L) for 1, 3 and 5-year 90.6%, 64.5% and 49.6%. According to univariate analysis, better prognosis for OS was associated with asymptomatic presentation, no ascites, small tumor, single lesion, serological AFP negativity, serological alkaline phosphatase (ALP) negativity, high-grade histological differentiation, no carcinoma cell embolus, no/mild cirrhosis, Child-Pugh class A, no transfusion, no regional lymph node metastasis, no major vascular invasion, no direct invasion of adjacent organs or with perforation of visceral peritoneum. In multivariate analysis, asymptomatic presentation, young age, single lesion, Alpha-Fetoprotein (AFP) negative expression, serological alkaline phosphatase (ALP) negative expression, Child-Pugh class A, no carcinoma cell embolus, serological no regional lymph node metastasis, no major vascular invasion, no direct invasion of adjacent organs, no perforation of visceral peritoneum and non-transfusion were independent factors for longer OS. Then all patients were classified into different groups by various OS time of 1, 2, 3, 5-year respectively. The statistical results showed that patients with a low expression of serum AFP had better prognosis.
Conclusion: Lower serum level of AFP indicates better prognosis while higher AFP level is directly correlated with more aggressive biological tumor activities, poor background of liver and poor prognosis.