Annals of Surgical Oncology

, Volume 19, Issue 12, pp 3687–3696

Is Serum Alpha-Fetoprotein Useful for Predicting Recurrence and Mortality Specific to Hepatocellular Carcinoma After Hepatectomy? A Test Based on Propensity Scores and Competing Risks Analysis

Authors

    • Department of Gastroenterology, Asan Liver Center, Asan Medical CenterUniversity of Ulsan College of Medicine
  • Da-Lim Yoon
    • Department of Gastroenterology, Asan Liver Center, Asan Medical CenterUniversity of Ulsan College of Medicine
  • Seungbong Han
    • Department of Biostatistics, Asan Medical CenterUniversity of Ulsan College of Medicine
  • Young-Joo Lee
    • Department of Surgery, Asan Liver Center, Asan Medical CenterUniversity of Ulsan College of Medicine
  • Sung-Gyu Lee
    • Department of Surgery, Asan Liver Center, Asan Medical CenterUniversity of Ulsan College of Medicine
  • Kang Mo Kim
    • Department of Gastroenterology, Asan Liver Center, Asan Medical CenterUniversity of Ulsan College of Medicine
  • Young-Suk Lim
    • Department of Gastroenterology, Asan Liver Center, Asan Medical CenterUniversity of Ulsan College of Medicine
  • Han Chu Lee
    • Department of Gastroenterology, Asan Liver Center, Asan Medical CenterUniversity of Ulsan College of Medicine
  • Young-Hwa Chung
    • Department of Gastroenterology, Asan Liver Center, Asan Medical CenterUniversity of Ulsan College of Medicine
  • Yung Sang Lee
    • Department of Gastroenterology, Asan Liver Center, Asan Medical CenterUniversity of Ulsan College of Medicine
Hepatobiliary Tumors

DOI: 10.1245/s10434-012-2416-1

Cite this article as:
Shim, J.H., Yoon, D., Han, S. et al. Ann Surg Oncol (2012) 19: 3687. doi:10.1245/s10434-012-2416-1

Abstract

Background

Serum alpha-fetoprotein (AFP) is frequently used to predict posthepatectomy outcomes in patients with hepatocellular carcinoma (HCC), but its predictive value is still not established. Therefore, we assessed the prognostic significance of AFP status.

Methods

Of 525 patients undergoing curative hepatectomy for HCC, 290 had preoperative AFP levels of ≥20 ng/mL (AFP-positive group) and 235 had AFP levels of <20 ng/mL (AFP-negative group). We compared the 2 groups with respect to time-to-recurrence, using the inverse probability of treatment weighted (IPTW) for the entire cohort and propensity score matching, and the cumulative incidence of HCC-specific mortality using competing risks regression.

Results

During follow-up (median duration 64 months, range 2–137 months), HCC recurred in 54.9 % of the AFP-negative group and 52.4 % of the AFP-positive group; there was no death without recurrence. After IPTW adjustment, time-to-recurrence did not differ in the 2 groups (hazard ratio [HR] 0.86, 95 % confidence interval [95 % CI] 0.66–1.12; P = 0.28). In a propensity-score matched cohort (152 pairs), time-to-recurrence data were similar to those obtained by IPTW adjustment (HR 0.91, 95 % CI 0.65–1.25; P = 0.55). There was no difference in recurrence pattern (site and stage) or treatment between the 2 groups even after propensity-score matching. The adjusted HR evaluating the impact of AFP positivity on the risk of HCC-specific mortality was 0.77 (95 % CI 0.54–1.08; P = 0.13) A multivariable competing risks analysis also failed to reveal a significant correlation between baseline AFP level and HCC-specific mortality in the AFP-positive group.

Conclusions

Preoperative AFP levels are not useful for predicting recurrence or survival endpoints following curative hepatectomy for HCC.

Supplementary material

10434_2012_2416_MOESM1_ESM.doc (112 kb)
Supplementary material 1 (DOC 112 kb)
10434_2012_2416_MOESM2_ESM.tif (1.5 mb)
Supplementary Fig. 1. Allocation scheme of patients based on serum AFP status before hepatic resection (TIFF 1526 kb)
10434_2012_2416_MOESM3_ESM.tif (1.3 mb)
Supplementary Fig. 2. ROC curves of serum AFP for predicting a recurrence and b death specific to HCC after hepatic resection at various time-points. The AUROCs of serum AFP were 0.53, 0.49, and 0.46, respectively, for predicting 1-, 3-, and 5-year recurrence and 0.51, 0.48, and 0.47, respectively, for predicting 3-, 5-, and 8-year mortality: the corresponding best cut-off values were 13.1 (circle), 12.1 (square), and 422,000 ng/mL (triangle), respectively, and 14.7 (circle), 2.8 (square), and 11.9 ng/mL (triangle), respectively. (TIFF 1305 kb)

Copyright information

© Society of Surgical Oncology 2012