Prognostic significance of combined α-fetoprotein and CA19-9 for hepatocellular carcinoma after hepatectomy

Abstract

Background The prognosis of hepatocellular carcinoma (HCC) varies considerably among patients with the same disease stage and characteristics, and only about two thirds show high levels of α-fetoprotein (AFP), a common prognostic indicator for HCC. Here, we assessed whether the combination of presurgical serum levels of AFP and carbohydrate antigen 19-9 (CA19-9) can predict the prognosis of HCC patients after hepatectomy. Methods The clinicopathological characteristics and post-hepatectomy outcomes of 711 HCC patients were retrospectively reviewed. The patients were classified into three groups based on whether their preoperative serum levels of both AFP and CA19-9 were higher than the respective cut-offs of 400 ng/ml and 37 U/ml [double positive (DP)], the level of only one marker was higher than the cut-off [single positive (SP)], or neither level was higher than the cut-off [negative (N)]. The overall survival (OS) and recurrence-free survival (RFS) rates were estimated using Kaplan–Meier curves. Univariate and multivariate survival analyses were performed to identify the clinicopathological factors significantly associated with HCC prognosis. Results The 1-year, 3-year, and 5-year RFS and OS rates in the N group were significantly higher than those in the SP group, while the DP group showed the lowest rates. Multivariate Cox regression analysis showed that large tumor size (> 5 cm), multiple tumors (≥ 2), incomplete tumor capsule, positive microvascular invasion, Barcelona Clinic Liver Cancer C stage, and CA19-9 level > 37 U/mL were independent risk factors for RFS and OS in HCC patients. Moreover, aspartate aminotransferase levels > 40 U/L proved to be an independent prognostic factor for OS. Conclusion The combination of serum AFP and CA19-9 levels may be a useful prognostic marker for HCC patients after hepatectomy.

Comparison of the Feasibility and Diagnostic Performance of ACR CEUS LI‐RADS and a Modified CEUS LI‐RADS for HCC in Examinations Using Sonazoid

“…There were 107 participants (78.1%) with a preoperative serum AFP level ≤400 ng/mL, and 30 (21.9%) with a level >400 ng/mL. In addition, 120 patients (87.6%) had a preoperative CA199 serum level ≤37 ng/mL, and 17 (12.4%) had a level >37 ng/mL 15 …”

“…In addition, 120 patients (87.6%) had a preoperative CA199 serum level ≤37 ng/mL, and 17 (12.4%) had a level >37 ng/mL. 15 Patient Stratification Using LI-RADS Classification Methods Table 3 shows the FLL percentages for each LI-RADS category based on the ACR LI-RADS and modified CEUS LI-RADS classifications as well as the distribution of pathological features and corresponding classifications. According to the ACR LI-RADS classification, there were 3 (2.1%) LR-3, 12 (8.6%) LR-4, 85 (60.7%) LR-5, and 40 (28.6%) LR-M nodules.…”

Bi-regional dynamic contrast-enhanced MRI for prediction of microvascular invasion in solitary BCLC stage A hepatocellular carcinoma

“…Our results revealed that AFP, corona enhancement, and TTPVI were independent predictors of MVI. AFP and corona enhancement could serve as indicators for tumor load and abnormal venous draining, which showed potential capacity in predicting MVI [ 25 , 29 ]. The tumor might destroy intra-tumoral hepatic veins and later compress peritumoral hepatic veins when MVI occurs, altering the venous drainage and leading to the occurrence of corona enhancement.…”

“…2 (See legend on next page.) [25,29]. The tumor might destroy intra-tumoral hepatic veins and later compress peritumoral hepatic veins when MVI occurs, altering the venous drainage and leading to the occurrence of corona enhancement.…”

External validation and improvement of the scoring system for predicting the prognosis in hepatocellular carcinoma after interventional therapy

“…Further, combined with other tumor markers could promote sensitivity, and specificity and make a reliable prognosis (29)(30)(31). The serum level of AFP correlated closely with tumor differentiation and aggressiveness (32), and was also a suggested indicator of hepatitis activity and severity, predicting the prognosis of HCC patients (33). DCP, another widely used highly specific diagnostic marker for HCC, could be a potentially potential predictor marker (34).…”