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.
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.
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.
Normal AFP level implies earlier staged tumors. BCLC has the strongest potential in prognosis evaluation in AFP negative patients.
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- Global cancer statistics, 2002.CA Cancer J Clin. 2005; 55: 74
- Alpha-fetoprotein in ontogenesis and its association with malignant tumors.Adv Cancer Res. 1971; 14: 295
- Alpha-1 fetoglobulin in the diagnosis of human hepatoma.N Engl J Med. 1968; 278: 984
- Diagnosing and monitoring hepatocellular carcinoma with alpha-fetoprotein: new aspects and applications.Clin Chim Acta. 2008; 395: 19
- Serum alpha-fetoprotein for diagnosis of hepatocellular carcinoma in patients with chronic liver disease: influence of HBsAg and anti-HCV status.J Hepatol. 2001; 34: 570
- Actual half-life of alpha-fetoprotein as a prognostic tool in pediatric malignant tumors.Pediatr Surg Int. 1997; 12: 599
- A new prognostic system for hepatocellular carcinoma: a retrospective study of 435 patients.Hepatology. 1998; 28: 751
- Prognostic factors after liver resection for hepatocellular carcinoma with hepatitis B virus-related cirrhosis: surgeon’s role in survival.Eur J Surg Oncol. 2009 Jun; 35: 622-628
- Prognostic factors after hepatic resection for hepatocellular carcinoma with hepatitis C viral infection: univariate and multivariate analysis.Am J Gastroenterol. 2001; 96: 1243
- American Joint Committee on cancer staging manual.6th ed. Springer, New York2002 (p. 131–44)
- Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Study of 850 patients.Cancer. 1985; 56: 918
- Prognosis of hepatocellular carcinoma: the BCLC staging classification.Semin Liver Dis. 1999; 19: 329
- A novel prognostic nomogram is more accurate than conventional staging systems for predicting survival after resection of hepatocellular carcinoma.J Am Coll Surg. 2008; 206: 281
- Prognostic staging system for hepatocellular carcinoma (CLIP score): its value and limitations, and a proposal for a new staging system, the Japan integrated staging score (JIS score).J Gastroenterol. 2003; 38: 207
- Diagnostic and prognostic role of α-fetoprotein in hepatocellular carcinoma: both or neither?.Am J Gastroenterol. 2006; 101: 524
- Alpha-fetoprotein induces suppressor T cells in vitro.Nature. 1977; 267: 257
- Further studies on the mechanism of suppression of human lymphocyte transformation by human alpha-fetoprotein.J Allergy Clin Immunol. 1980; 65: 127
- Clinical management of hepatocellular carcinoma. Conclusion of the Barcelona – 2000 EASL conference.J Hepatol. 2001; 35: 421
- Prognostic prediction and treatment strategy in hepatocellular carcinoma.Hepatology. 2002; 35: 519
- A consensus conference on prognostic studies in hepatology.J Hepatol. 1999; 30: 171
- Letter to the editor.Hepatology. 2000; 32: 679
- Prognosis of hepatocellular carcinoma: comparison of 7 staging systems in an American cohort.Hepatology. 2005; 41: 707
- Prospective validation of the Barcelona Clinic Liver Cancer staging system.J Hepatol. 2006; 44: 723
- Comparison of three current staging systems for hepatocellular carcinoma: Japan integrated staging score, new Barcelona Clinic Liver Cancer staging classification, and Tokyo score.J Gastroenterol Hepatol. 2008; 23: 445
- Prognostic factors for survival in patients with early-intermediate hepatocellular carcinoma undergoing non-surgical therapy: comparison of Okuda, CLIP, and BCLC staging systems in a single Italian centre.Gut. 2005; 54: 411
- Practice Guidelines Committee, American association for the Study of Liver Diseases. Management of hepatocellular carcinoma.Hepatology. 2005; 42: 1208
- Hepatectomy for stage B and stage C hepatocellular carcinoma in the Barcelona Clinic Liver Cancer classification: results of a prospective analysis.Arch Surg. 2008; 143: 1082
- Simplified staging for hepatocellular carcinoma.J Clin Oncol. 2002; 20: 1527
Accepted: May 17, 2010
© 2010 Published by Elsevier Inc.