Hong-Fan Ding1, Xu-Feng Zhang2, Fabio Bagante3, Francesca Ratti4, Hugo P Marques5, Olivier Soubrane6, Vincent Lam7, George A Poultsides8, Irinel Popescu9, Sorin Alexandrescu9, Guillaume Martel10, Aklile Workneh10, Alfredo Guglielmi4, Tom Hugh11, Luca Aldrighetti4, Yi Lv1, Timothy M Pawlik12. 1. Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China. 2. Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner, Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA. 3. Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner, Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA; Department of Surgery, University of Verona, Verona, Italy. 4. Department of Surgery, Ospedale San Raffaele, Milan, Italy. 5. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal. 6. Department of Hepatobiliopancreatic Surgery, APHP, Beaujon Hospital, Clichy, France. 7. Department of Surgery, Westmead Hospital, Sydney, Australia. 8. Department of Surgery, Stanford University, Stanford, CA, USA. 9. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania. 10. Department of Surgery, University of Ottawa, Ottawa, Canada. 11. Department of Surgery, The University of Sydney, School of Medicine, Sydney, Australia. 12. Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner, Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA. Electronic address: Tim.Pawlik@osumc.edu.
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.
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.