Alpha-Fetoprotein Ratio Predicts Alpha-Fetoprotein Positive Hepatocellular Cancer Patient Prognosis after Hepatectomy

Abstract

Background. This study was conducted to investigate the effect of alpha-fetoprotein (AFP) ratio on the prognosis of AFP-positive hepatocellular carcinoma (HCC) patients after hepatectomy. Methods. We retrospectively included 879 HCC patients with AFP-positive who underwent hepatectomy from February 2012 to October 2017 and randomly divided into training cohort and validation cohort. AFP ratio was equal to the AFP level within one week before hepatectomy to AFP level within 20-40 days after surgery. The end point of follow-up was disease-free survival (DFS) and overall survival (OS). Results. AFP ratio was not associated with clinical characteristics in training cohort and validation cohort. According to the X-tile software, the optimum cut-off point was 17.8 for AFP ratio. Significant differences between AFP ratio high and AFP ratio low were observed in DFS and OS in both cohort ( p < 0.05 ). Kaplan-Meier curves and receiver-operating curves were showed that AFP ratio was better than AFP level preoperation in predicting the prognosis of AFP-positive HCC patients after hepatectomy. The multivariate analysis demonstrated that AFP ratio was a significant independent risk factor for both OS and DFS in HCC patients with AFP-positive. Conclusions. AFP ratio might be a prognosis predictor for HCC patients with AFP-positive after hepatectomy.

The Prognostic Value of Alpha-Fetoprotein Ratio in Patients With Resectable Alpha-Fetoprotein-Negative Hepatocellular Carcinoma

“…13 In a previous study, we found that AFP-positive HCC patients with a low AFP ratio had a poorer prognosis compared to those with a high AFP ratio. 8 However, the prognostic significance of the AFP ratio in AFP-negative HCC patients after surgery remains unclear. Therefore, in this retrospective analysis, we aimed to investigate the impact of the AFP ratio in AFP-negative HCC patients after hepatectomy.…”

“…Additionally, the AFP ratio was calculated as the ratio of serum AFP level within 1 week prior to surgery to serum AFP level 20-40 days after hepatectomy. 8 Follow-up data were collected from the patients' medical records.…”

“…7 In our previous study, we found that the ratio of AFP level before hepatectomy to the level after hepatectomy can predict prognosis in AFP-positive HCC patients. 8 However, there is a lack of study on AFP ratio in AFP-negative HCC patients. Another study also demonstrated that AFP-negative HCC patients with a positive AFP level at the time of relapse have a higher mortality rate compared to those with a negative AFP level at relapse.…”