Alpha-fetoprotein level to total tumor volume as a predictor of hepatocellular carcinoma recurrence after resection. A retrospective cohort study

Hazem M Zakaria; Anwar Mohamed; Hazem Omar; Nahla K Gaballa

doi:10.1016/j.amsu.2020.04.014

Alpha-fetoprotein level to total tumor volume as a predictor of hepatocellular carcinoma recurrence after resection. A retrospective cohort study

Ann Med Surg (Lond). 2020 May 4:54:109-113. doi: 10.1016/j.amsu.2020.04.014. eCollection 2020 Jun.

Authors

Hazem M Zakaria¹, Anwar Mohamed², Hazem Omar³, Nahla K Gaballa⁴

Affiliations

¹ Department of Hepatopancreatobiliary and Liver Transplant Surgery, National Liver Institute, Menoufia University, Egypt.
² Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Egypt.
³ Department of Diagnostic and Intervention Radiology, National Liver Institute, Menoufia University, Egypt.
⁴ Department of Anesthesiology and Intensive Care, National Liver Institute, Menoufia University, Egypt.

Abstract

Background: Total tumor volume (TTV) and serum alfa fetoprotein (AFP) level are important risk factors linked with the high possibility of hepatocellular carcinoma (HCC) recurrence. The aim of the study was to evaluate the role of AFP/TTV ratio, as a prognostic marker, in the prediction of HCC recurrence after resection.

Methods: Patients who underwent liver resection for HCC between 2010 and 2018 were retrospectively analyzed. Patients were divided into 2 groups; a group with AFP/TTV ≤2 and another group with AFP/TTV >2. Risk factors for HCC recurrence were recorded.

Results: A total of 286 HCC patients underwent liver resection (184 patients with AFP/TTV ≤ 2, and 102 patients with AFP/TTV > 2). There was a significant difference between the 2 groups in the preoperative total bilirubin level, serum AFP level, mean tumor diameter, TTV, operative blood loss, microvascular invasion and hospital stay (all P values < 0.05). The 1-, 3-, and 5-year tumor recurrence rates were 24.1%, 43%, and 57.6% respectively. The independent risk factors for tumor recurrence were AFP/TTV >2 (HR = 1.62, 95% CI = 1.29-1.98, P = 0.042), Macrovascular invasion (HR = 2.03, 95% CI = 2.17-2.38, P = 0.021, and microvascular invasion (HR = 1.36, 95% CI = 1.08-1.77, P = 0.019).

Conclusion: AFP/TTV ratio is a feasible prognostic marker for prediction of HCC recurrence after resection so, it can help in providing an intensive postoperative surveillance program to high risk patients for early detection and management of any recurrence.

Keywords: Alfa fetoprotein; Hepatocellular carcinoma; Liver resection; Total tumor volume.