Prognosis evaluation in alpha-fetoprotein negative hepatocellular carcinoma after hepatectomy: Comparison of five staging systems

Abstract 

Aims

Alpha-fetoprotein (AFP) loses its potentials in treatment evaluation and prognosis prediction in patients with AFP negative (≤20 ng/ml) hepatocellular carcinoma (HCC). The present study was to identify the risk factors affecting postoperative survival of AFP negative patients and to determine the optimal staging system in predicting the survival of these patients.

Methods

The data of 306 in total and 98 AFP negative patients amongst were retrospectively reviewed. The risk factors affecting survivals of the patients were identified. And various staging systems were compared, including the sixth tumor node metastasis (TNM) system, Okuda staging, Cancer of the Liver Italian Program (CLIP) score, the Barcelona Clinic Liver Cancer (BCLC) staging system, and the Japan Integrated Staging (JIS) score.

Results

AFP negative patients tended to have intact tumor capsule and earlier staged tumor by TNM, CLIP and BCLC. The independent risk factors worsening overall survival of AFP negative patients were absence of tumor capsule, Child-Pugh classification B, hepatitis B surface antigen positive and BCLC stage B–C. The risk factors promoting tumor recurrence were tumor size of >3 cm, distribution in two lobes, Okuda stage B–C and BCLC stage B–C.

Conclusion

Normal AFP level implies earlier staged tumors. BCLC has the strongest potential in prognosis evaluation in AFP negative patients.

Keywords: Surgery, Hepatocellular carcinoma, Alpha-fetoprotein, Staging system, Prognosis