TY - JOUR
T1 - Prediction of tumor recurrence by α-fetoprotein model after curative resection for hepatocellular carcinoma
AU - Ding, Hong-Fan
AU - Zhang, Xu-Feng
AU - Bagante, Fabio
AU - Ratti, Francesca
AU - Marques, Hugo P.
AU - Soubrane, Olivier
AU - Lam, Vincent
AU - Poultsides, George A.
AU - Popescu, Irinel
AU - Alexandrescu, Sorin
AU - Martel, Guillaume
AU - Workneh, Aklile
AU - Guglielmi, Alfredo
AU - Hugh, Tom
AU - Aldrighetti, Luca
AU - Lv, Yi
AU - Pawlik, Timothy M.
PY - 2021/3
Y1 - 2021/3
N2 - 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.
AB - 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.
KW - Alpha-fetoprotein
KW - Barcelona clinic liver cancer
KW - Hepatocellular carcinoma
KW - Surgery
UR - http://www.scopus.com/inward/record.url?scp=85092796745&partnerID=8YFLogxK
U2 - 10.1016/j.ejso.2020.10.017
DO - 10.1016/j.ejso.2020.10.017
M3 - Article
C2 - 33082065
AN - SCOPUS:85092796745
SN - 0748-7983
VL - 47
SP - 660
EP - 666
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 3 Pt B
ER -