Assessing Prognostic Significance of Preoperative Alpha-Fetoprotein in Hepatitis B-Associated Hepatocellular Carcinoma: Normal is not the New Normal

Abstract

Preoperative serum AFP is an independent predictor of prognosis among HBV-HCC patients following surgical resection. Categorizing AFP into quintiles creates the opportunity to observe differences in outcomes even at low serum levels within the normal range. Additionally, combining AFP quintiles and fibrosis staging provides a predictive model of prognosis for HCC. Thus, even small differences in AFP within the normal range may impact prognosis and disease progression for HBV-HCC.

The Severity of Liver Fibrosis Influences the Prognostic Value of Inflammation-Based Scores in Hepatitis B-Associated Hepatocellular Carcinoma

“…3,[20][21][22] The degree of hepatic fibrosis and HAI to measure necroinflammation were scored using the modified Ishak method (stage 0-6). 23 Patient diagnosis and follow-up were performed as previously described.…”

“…23 Patient diagnosis and follow-up were performed as previously described. 3,[20][21][22] Preoperative neutrophil count, lymphocyte count, platelet count, and serum albumin concentration also were obtained from the medical record to compute NLR (neutrophil/lymphocyte ratio), PLR (platelet/lymphocyte ratio), and PNI (albumin (g/L) ? 5 9 lymphocyte count 9 10 9 /L).…”

The prognostic utility of baseline alpha‐fetoprotein for hepatocellular carcinoma patients

“…Many early‐stage HCC patients do not express elevated AFP levels, and patients with chronic diseases like hepatitis and cirrhosis may have elevated serum AFP in the absence of malignancy . However, following definitive diagnosis of HCC, elevated pretreatment AFP has been described as an independent predictor of survival and recurrence in several institutional studies and reviews …”

Stratified Platelet-to-lymphocyte Ratio: A Novel Target for Prognostic Prediction of Hepatocellular Carcinoma after Curative Liver Resection

“…For instance, Blank et al 47 categorized AFP into quintiles and created the opportunity to observe differences in outcomes among HBV-HCC patients after surgical resection. And, another study categorized patients into equal tertiles according to their baseline of NLR and PLR, demonstrating that an elevated pretreatment NLR is an independent predictor of both worse overall and disease-free survival in colorectal cancer 48.…”