Is inconsistency of α-fetoprotein level a good prognosticator for hepatocellular carcinoma recurrence?

Table 1 Clinical characteristics of groups I, II, and III

	Group I (n = 16)	Group II (n = 24)	Group III (n = 29)	P
Age (yr)	59.7 ± 12.5	57.1 ± 16.6	48.8 ± 16.3	0.055
Gender (M/F)	10/6	12/12	19/10	0.498
Tumor size (cm)	5.64 ± 3.07	4.80 ± 3.40	5.08 ± 3.11	0.696
ALT (U/L)	74.1 ± 50.9	77.2 ± 84.4	60.6 ± 44.1	0.615
T Bil (mg/dL)	0.79 ± 0.32	0.88 ± 0.49	0.96 ± 0.54	0.496
Albumin (g/dL)	3.74 ± 0.60	3.99 ± 0.50	3.74 ± 0.55	0.196
Plat (103/μL)	154.0 ± 65.8	134.9 ± 68.3	181.1 ± 94.5	0.155
Vessel invasion (+/-)	4/12	6/18	8/21	0.971
Tumor number (S/M)	9/7	16/8	15/14	0.541
AJCC I/II/III	6/2/8	14/4/6	9/6/14	0.282
Child A/B	13/3	22/2	23/6	0.445
HBV (+/-)	12/4	15/9	25/4	0.241
HCV (+/-)	5/11	7/14	6/23	0.678
Cirrhosis (+/-)	10/6	14/10	20/9	0.720
AFP (op) (ng/dL)	1582 ± 2645	3049 ± 7215	2776 ± 6696	0.751
AFP (recur) (ng/dL)	7.5 ± 5.2	86.8 ± 57.9	8162.3 ± 15 250.7	0.006
Recur interval (mo)	21.8 ± 14.6	12.3 ± 7.7	8.3 ± 6.6	< 0.001
Recur-to-death (mo)	18.4 ± 19.5	24.1 ± 19.8	13.6 ± 19.6	0.162
Survival time (mo)	40.2 ± 19.9	36.1 ± 22.4	21.9 ± 22.0	0.013
Intra-hepatic recur	2/14	8/16	17/8	0.001

ALT: Alanine aminotransferase; T Bil: Total bilirubin; Plat: Platelet; Child: Child-Pugh classification; AJCC: American Joint Committee on Cancer; HBV (+): Hepatitis B virus infection; HCV (+): Hepatitis C virus infection; Cirrhosis (+): Cirrhotic change by pathologic finding; AFP (op): α-fetoprotein level preoperatively; AFP (recur): α-fetoprotein level at tumor recurrence; Recur interval: The interval from operation to tumor recurrence; Recur-to-death: The interval from tumor recurrence to patient’s death; Survival time: The time from operation to last follow-up date or death date; Intra-hepatic recur: Hepatocellular carcinoma (HCC) recurrence located at the adjacent segment, section and same lobe/HCC recurrence located at contralateral liver lobe.

Table 2 Cox regression analysis of outcome for clinical parameters of HCC patients after curative liver resection

	Univariate analysis			Multivariate analysis
	RR	95% CI	P	RR	95% CI	P
Age (yr) > 50/ ≤ 50	1.023	0.532-1.968	0.95
Gender (M/F)	0.640	0.325-1.262	0.20
Tumor size (cm) > 5/ ≤ 5	0.444	0.230-0.856	0.02	0.836	0.404-1.729	0.63
ALT (U/L) > 40/ ≤ 40	0.929	0.471-1.831	0.83
T Bil (mg/dL) > 1.2/ ≤ 1.2	0.357	0.175-0.730	0.005	0.430	0.159-1.168	0.10
Albumin (g/dL) > 3.5/ ≤ 3.5	1.674	0.867-3.232	0.13
Plat (103/μL) > 10/ ≤ 10	1.600	0.808-3.169	0.18
Vessel invasion (–/+)	0.470	0.228-0.969	0.04	0.251	0.096-0.658	0.005
Tumor number (S/M)	1.073	0.556-2.070	0.83
Child B/A	0.372	0.182-0.759	0.007	0.452	0.153-1.339	0.15
HBV (-/+)	0.598	0.262-1.363	0.22
HCV (-/+)	1.514	0.688-3.334	0.30
Cirrhosis (-/+)	0.885	0.452-1.734	0.72
Group I reference			0.005			0.04
II/I	0.371	0.162-0.846	0.02	2.142	0.569-7.000	0.02
III/I	0.318	0.144-0.700	0.004	0.582	0.254-3.033	0.12
AFP (op) (ng/dL) > 200/ ≤ 200	0.048	0.000-14 716.4	0.64
AFP (recur) (ng/dL) > 200/ ≤ 200	0.341	0.177-0.653	0.001	0.851	0.301-1.389	0.45
Recur interval (mo) > 12/ ≤ 12	2.550	1.265-5.145	0.009	2.438	1.112-5.348	0.03
Path grade I reference			0.42
II/I	0.821	0.376-1.795	0.62
III/I	0.504	0.197-1.291	0.15

Path grade I, II, III: Histopathologic grade of HCC. I: Well differentiated; II: Moderately differentiated; and III: Poor or undifferentiated.