Prognostic role of pre-treatment serum AFP-L3% in hepatocellular carcinoma: systematic review and meta-analysis

Jiwen Cheng; Wanli Wang; Yingjun Zhang; Xi Liu; Muxing Li; Zheng Wu; Zhengwen Liu; Yi Lv; Bo Wang

doi:10.1371/journal.pone.0087011

Prognostic role of pre-treatment serum AFP-L3% in hepatocellular carcinoma: systematic review and meta-analysis

PLoS One. 2014 Jan 30;9(1):e87011. doi: 10.1371/journal.pone.0087011. eCollection 2014.

Authors

Jiwen Cheng¹, Wanli Wang², Yingjun Zhang³, Xi Liu⁴, Muxing Li¹, Zheng Wu⁵, Zhengwen Liu⁶, Yi Lv¹, Bo Wang⁵

Affiliations

¹ Department of Hepatobiliary Surgery, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi, China ; Institute of Advanced Surgical Technology and Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
² Department of Hepatobiliary Surgery, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi, China ; Department of General Surgery, Bazhong Central Hospital, Bazhong, Sichuan, China.
³ Department of General Surgery, Bazhong Central Hospital, Bazhong, Sichuan, China.
⁴ Department of Pathology, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
⁵ Department of Hepatobiliary Surgery, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
⁶ Institute of Advanced Surgical Technology and Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China ; Department of Infectious Diseases, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi, China.

Abstract

Background: Serum lens culinaris agglutinin-reactive fraction of α-fetoprotein (AFP-L3%) has been widely used for HCC diagnosis and follow-up surveillance as tumor serologic marker. However, the prognostic value of high pre-treatment serum AFP-L3% in patients with hepatocellular carcinoma (HCC) remains controversial. We therefore conduct a meta-analysis to assess the relationship between high pre-treatment serum AFP-L3% and clinical outcome of HCC.

Methods: Eligible studies were identified through systematic literature searches. A meta-analysis of fifteen studies (4,465 patients) was carried out to evaluate the association between high pre-treatment serum AFP-L3% and overall survival (OS) and disease-free survival (DFS) in HCC patients. Sensitivity and subgroup analyses were also conducted in this meta-analysis.

Results: Our analysis results showed that high pre-treatment serum AFP-L3% implied poor OS (HR: 1.65, 95%CI: 1.45-1.89 p<0.00001) and DFS (HR: 1.80, 95% CI: 1.49-2.17 p<0.00001) of HCC. Subgroup analysis revealed that there was association between pre-treatment serum AFP-L3% and endpoint (OS and DFS) in low AFP concentration HCC patients (HR: 1.96, 95% CI: 1.24-3.10, p = 0.004; HR: 2.53, 95% CI: 1.09-5.89, p = 0.03, respectively).

Conclusion: The current evidence suggests that high pre-treatment serum AFP-L3% levels indicated a poor prognosis for patients with HCC and AFP-L3% may have significant prognostic value in HCC patients with low AFP concentration.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Carcinoma, Hepatocellular / blood*
Carcinoma, Hepatocellular / mortality
Carcinoma, Hepatocellular / therapy
Disease-Free Survival
Humans
Liver Neoplasms / blood*
Liver Neoplasms / metabolism
Liver Neoplasms / therapy
Prognosis
Proportional Hazards Models
Treatment Outcome
alpha-Fetoproteins / metabolism*

Substances

alpha-Fetoproteins

Grants and funding

This work was supported in part by the National Natural Science Foundation of China (Grant no. 81270521). No additional external funding was received for this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.