Clinical Characteristics and Prognosis of Hepatocellular Carcinoma

Abstract

The purpose of this study was to determine whether a relation does exist between clinicopathologic features and the prognosis of hepatocellular carcinoma (HCC) with respect to serum alpha-fetoprotein (AFP) levels at diagnosis. We reviewed the clinical data of 309 pathologically proven HCC cases divided into three groups: group 1 with normal AFP (<20 IU/mL), group 2 with moderately elevated AFP (20-399 IU/mL) and group 3 with markedly elevated AFP (> or =400 IU/mL). Of these, there were 76 (24.6%), 78 (25.2%), and 155 patients (50.2%) in groups 1, 2, and 3, respectively. We found that HCC patients with high AFP tended to have greater tumor size, bilobar involvement, massive or diffuse types, and portal vein thrombosis. Nonetheless, we could not establish a correlation between increased AFP and Okuda's stages, degree of tumor differentiation, or extrahepatic metastasis. The median survival rates in groups 1 (6 months) and 2 (7 months) were significantly longer than that of group 3 (3 months). On multivariate logistic regression analysis, positive hepatitis B surface antigen (HBsAg) status and bilobar tumor involvement represented the independent factors for predicting high AFP values. We concluded that AFP is useful not only for diagnosis, but also as a prognostic indicator in patients with HCC . However, it cannot be considered a sensitive tumor marker, particularly during the early stages in HBsAg-negative patients.

Prognostic Value of Serum AFP, AFP-L3, and GP73 in Monitoring Short-term Treatment Response and Recurrence of Hepatocellular Carcinoma after Radiofrequency Ablation

“…Many studies (Tangkijvanich et al, 2000;Fujioka et al, 2001;Carr et al, 2007;Yamamoto et al, 2010;Saito et al, 2012) revealed that AFP levels > 400 ng/mL were indicative of larger tumor size, greater tumor numbers, a later clinical phase, bile duct invasion, vascular invasion, and a shorter median survival time. Elevated AFP-L3 levels were associated with larger tumor size, a later clinical stage, vascular invasion, poor tumor differentiation, and distant metastasis (Oka et al, 2001;Yoshida et al, 2002;Carr et al, 2007;Saito et al, 2012).…”

Proteomic signature corresponding to alpha fetoprotein expression in liver cancer cells

“…10 These pathological and clinical features could be explained by a common protein network with AFP expression. Taking annexin A1 as an example, this protein is a major substrate for tyrosine kinases such as epidermal growth factor receptor and serine/threonine kinases such as protein kinase C 43,44 and has been implicated in cellular signal transduction.…”

“…9 Serum AFP alone has a limited role in the early diagnosis of HCC, because a considerable proportion of HCC patients do not have elevated serum AFP, and serum AFP can increase in patients with diseases other than HCC; it may, however, be a useful prognostic indicator, because the median survival rate of HCC patients with markedly elevated AFP was significantly shorter than that of patients with normal or moderately elevated AFP. 10 AFP is a multifunctional glycoprotein belonging to the family of albumin-like proteins. 11 AFP has been shown to serve as a dual regulator of growth in a multitude of cell types and cancers involving several mechanisms, including apoptotic regulation.…”

“…Because higher expression of AFP often is associated with greater tumor size, histological undifferentiation, and portal vein thrombosis, 10 and it is unlikely that any single protein is directly responsible for such a variety of characteristics, we hypothesized that multiple proteins may function in a coordinate manner with AFP. Although discordance of messenger RNA and protein expression has been reported, [21][22][23][24] the DNA microarray data for AFP-producing cells were not examined at the protein level, and a proteomic study has not yet been performed.…”

Discrimination value of the new western prognostic system (CLIP score) for hepatocellular carcinoma in 662 Japanese patients

“…4 In fact, the well-known UICC and AJCC staging (TNM) criteria do not define the relative prognostic weight of variables, in terms of residual liver function. 5 Although several studies have examined predictive factors for prognosis in relation to treatment, 1,[6][7][8][9][10][11][12][13][14][15][16] most of these have been performed in Asian institutions. Accordingly, these facilities and patient populations possess early detection plans, risk factors for primary liver cancer, a high proportion of expanding tumors, and differing rates of resectability, respectively, with regard to those in Western countries.…”