Brief Article
Copyright ©2010 Baishideng. All rights reserved
World J Gastroenterol. Jun 28, 2010; 16(24): 3049-3055
Published online Jun 28, 2010. doi: 10.3748/wjg.v16.i24.3049
Is inconsistency of α-fetoprotein level a good prognosticator for hepatocellular carcinoma recurrence?
Chung-Bao Hsieh, Teng-Wei Chen, Chi-Ming Chu, Heng-Cheng Chu, Cheng-Ping Yu, Kuo-Piao Chung
Chung-Bao Hsieh, Teng-Wei Chen, Division of General Surgery, Tri-Service General Hospital, Taipei 114, Taiwan, China
Chung-Bao Hsieh, Kuo-Piao Chung, Graduate Institute of Health Care Organization Administration, National Taiwan University, Taipei 100, Taiwan, China
Chi-Ming Chu, Section of Biostatistics and Informatics, Department of Epidemiology, School of Public Health, National Defense Medical Center, Taipei 114, Taiwan, China
Heng-Cheng Chu, Department of Internal Medicine, Tri-Service General Hospital, Taipei 114, Taiwan, China
Cheng-Ping Yu, Department of Pathology, Tri-Service General Hospital, Taipei 114, Taiwan, China
Author contributions: Hsieh CB and Chung KP designed the research; Chu CM analyzed the data; Hsieh CB and Chu HC performed the research; Yu CP contributed to the pathology review; Hsieh CB and Chen TW wrote the paper.
Correspondence to: Kuo-Piao Chung, PhD, Associated Professor, Graduate Institute of Health Care Organization Administration, National Taiwan University, Room 635, No. 17, Suchow Rd, Taipei 100, Taiwan, China. kpchung@ntu.edu.tw
Telephone: +886-2-33668065 Fax: +886-2-23434200
Received: February 10, 2010
Revised: March 25, 2010
Accepted: April 2, 2010
Published online: June 28, 2010
Abstract

AIM: To identify the clinical outcomes of hepatocellular carcinoma (HCC) patients with inconsistent α-fetoprotein (AFP) levels which were initially high and then low at recurrence.

METHODS: We retrospectively included 178 patients who underwent liver resection with high preoperative AFP levels (≥ 200 ng/dL). Sixty-nine HCC patients had recurrence during follow-up and were grouped by their AFP levels at recurrence: group I, AFP ≤ 20 ng/dL (n = 16); group II, AFP 20-200 ng/dL (n = 24); and group III, AFP ≥ 200 ng/dL (n = 29). Their preoperative clinical characteristics, accumulated recurrence rate, and recurrence-to-death survival rate were compared. Three patients, one in each group, underwent liver resection twice for primary and recurrent HCC. AFP immunohistochemistry of primary and recurrent HCC specimens were examined.

RESULTS: In this study, 23% of patients demonstrated normal AFP levels at HCC recurrence. The AFP levels in these patients were initially high. There were no significant differences in clinical characteristics between the three groups except for the mean recurrence interval (21.8 ± 14.6, 12.3 ± 7.7, 8.3 ± 6.6 mo, respectively, P < 0.001) and survival time (40.2 ± 19.9, 36.1 ± 22.4, 21.9 ± 22.0 mo, respectively, P = 0.013). Tumor size > 5 cm, total bilirubin > 1.2 mg/dL, vessel invasion, Child classification B, group III, and recurrence interval < 12 mo, were risk factors for survival rate. Cox regression analysis was performed and vessel invasion, group III, and recurrence interval were independent risk factors. The recurrence interval was significant longer in group I (P < 0.001). The recurrence-to-death survival rate was significantly better in group II (P = 0.016). AFP staining was strong in the primary HCC specimens and was reduced at recurrence in group I specimens.

CONCLUSION: Patients in group I with inconsistent AFP levels had a longer recurrence interval and worse recurrence-to-death survival rate than those in group II. This clinical presentation may be caused by a delay in the detection of HCC recurrence.

Keywords: Hepatocellular carcinoma; Inconsistent α-fetoprotein; Outcome; Recurrence