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Alkaline Phosphatase: Does it have a Role in Predicting Hepatocellular Carcinoma Recurrence?

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Backgrounds

Surgical resection remains the first line of treatment for earlier stages of hepatocellular carcinoma (HCC), and it offers the best prognosis for long-term survival. Nevertheless, the recurrence rates after resection are still high in reports. Therefore, it is still essential to explore any potential prognostic factors to attain relatively longer-term survival of HCC patients.

Materials and Methods

In the period from 1983 to 2005, 1,685 patients who underwent hepatectomy at Chang Gung Memorial hospital were enrolled in the study, and their clinicopathological data were retrospectively reviewed for survival analysis.

Results

The 1-, 3-, 5-, and 10-year disease-free survival (DFS) rates in this series were 60.3%, 39.7%, 31.3%, and 24.0%, respectively, whereas the 1-, 3-, 5-, and 10-year overall survival (OS) rates were 80.1%, 59.1%, 46.6%, and 27.7%, respectively. Gross vascular invasion, tumor status, lymph node involvement, satellite lesion, positive surgical margin, alkaline phosphatase (ALP), albumin, presence of cirrhosis, and Child grade B or C were independent prognostic factors for prediction of DFS; while α-fetoprotein, ALP, surgical factors, including complications, blood transfusion, positive resection margin, and tumor characters including tumor status, vascular invasion, and lack of tumor encapsulation were found to be independent predicting factors for OS, as determined by Cox regression analysis. Interestingly, we found that preoperative level of ALP was one of the most important independent predictors of recurrence, even more important that α-fetoprotein (AFP) as we noticed that elevation of ALP above (82 U/L) predicted poor prognosis in patients where AFP levels was less than 66 ng/ml. It is worth to mention that ALP was statistically related to other liver function tests, but not tumor characters by hierarchical clustering; which means that we were able to correlate ALP with prognosis statistically, but not with pathological criteria of the tumor; to elucidate these finding, further basic science research is required.

Conclusion

ALP among liver function tests, in addition to other tumor characters were independent factors for DFS and OS; our results suggest that preoperative ALP levels could be utilized to monitor and predict recurrence in high risk HCC patients.

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Acknowledgements

This study was supported by the Chang Gung Medical Research Fund (CMRP 361522). The authors acknowledge Ms. Shu-Fang Huang and Ms. Yun-Chieh Lai for data collection and secretarial assistance.

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Authors and Affiliations

  1. Department of Surgery, Chang Gung Memorial Hospital, Linkou No. 5, Fu-Hsing Street, Kuei Shan Hsiang, Taoyuan county, 333, Taiwan

    Ming-Chin Yu, Kun-Ming Chan, Chen-Fang Lee, Firas Zahr Eldeen, Hong-Shiue Chou, Wei-Chen Lee & Miin-Fu Chen

  2. Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan

    Ming-Chin Yu

  3. Genomic Medicine Research Core Laboratory, Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Yun-Shien Lee

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  1. Ming-Chin Yu
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  2. Kun-Ming Chan
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Correspondence to Wei-Chen Lee.

Additional information

There is no commercial interest in the study and the financial support is from Chang Gung Medical Research funding, CMRP 361522.

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Yu, MC., Chan, KM., Lee, CF. et al. Alkaline Phosphatase: Does it have a Role in Predicting Hepatocellular Carcinoma Recurrence?. J Gastrointest Surg 15, 1440–1449 (2011). https://doi.org/10.1007/s11605-011-1537-3

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  • DOI: https://doi.org/10.1007/s11605-011-1537-3

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