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Preoperative Carbohydrate Antigen 19-9: Its Neglected Role in Alpha-Fetoprotein-Negative Hepatocellular Carcinoma Patients

Journal of Gastrointestinal Surgery volume 21, pages 2025–2032 (2017)Cite this article

Abstract

Purpose

The study aimed to investigate the prognostic role of the preoperative carbohydrate antigen 19-9 (CA19-9) level in alpha-fetoprotein (AFP)-negative (AFP < 25 ng/ml) hepatocellular carcinoma (HCC) patients.

Methods

From December 2004 to December 2013, 750 patients diagnosed with AFP-negative HCC following curative resection were enrolled. Both univariate and multivariate analyses were performed to clarify the prognostic factors for overall survival (OS) and disease-free survival (DFS).

Results

The optimal cutoff point for preoperative CA19-9 was 32.6 U/ml, and the value of the area under the curve was 0.640. The 1-, 3-, and 5-year OS rates were 88.4, 72.2, and 57.0%, respectively, for the CA19-9 > 32.6 U/ml group and 97.0, 83.3, and 79.9%, respectively, for the CA19-9 ≤ 32.6 U/ml group (P < 0.001). The 1-, 3-, and 5-year DFS rates were 71.8, 47.7, and 34.8%, respectively, for the CA19-9 > 32.6 U/ml group and 80.8, 63.6, and 55.5%, respectively, for the CA19-9 ≤ 32.6 U/ml group (P < 0.001). The multivariate analysis showed that CA19-9 > 32.6 U/ml was one of the most significant unfavorable predictors of OS and DFS (P < 0.001 for both).

Conclusions

Preoperative CA19-9 > 32.6 U/ml is a predictor of dismal prognosis and can be employed as a prognostic marker for patient selection in AFP-negative HCC management.

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Acknowledgments

This study was supported by grants from the National Natural Science Foundation of China (No. 81172037/H1606) and the Guangdong Province Science and Technology Project of China (No. 2013B021800159). We are also grateful to and thank all the patients who participated in this study.

Author information

Author notes

  1. Liang-He Lu and Yong-Fa Zhang contributed equally to this study.

Affiliations

  1. Department of Hepatobiliary Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, 510060, People’s Republic of China

    Liang-He Lu, Wei Wei, Ming Shi & Rong-Ping Guo

  2. State Key Laboratory of Oncology in South China, Guangzhou, People’s Republic of China

    Liang-He Lu, Wei Wei, Ming Shi & Rong-Ping Guo

  3. Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China

    Liang-He Lu, Wei Wei, Ming Shi & Rong-Ping Guo

  4. Department of Liver Surgery, Fudan University Shanghai Cancer Center, Shanghai, China

    Yong-Fa Zhang

  5. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

    Yong-Fa Zhang

  6. Department of Laboratory, Fudan University Shanghai Cancer Center, Shanghai, China

    Yong-Fa Zhang

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  1. Liang-He Lu
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Contributions

Guo RP and Lu LH designed the study; Lu LH and Zhan YF collected and analyzed the data, performed the statistical analysis, and wrote the manuscript (Lu LH and Zhan YF made equal contributions); and Guo RP, Wei W, and Shi M analyzed the data and contributed to the discussion and revision.

Corresponding author

Correspondence to Rong-Ping Guo.

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Financial Support

This study was supported by grants from the Guangdong Province Science and Technology Project of China (No. 2013B021800159).

Conflict of Interest

The authors declare that they have no conflicts of interest.

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Cite this article

Lu, LH., Zhang, YF., Wei, W. et al. Preoperative Carbohydrate Antigen 19-9: Its Neglected Role in Alpha-Fetoprotein-Negative Hepatocellular Carcinoma Patients. J Gastrointest Surg 21, 2025–2032 (2017). https://doi.org/10.1007/s11605-017-3528-5

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Keywords

  • Hepatocellular carcinoma
  • AFP-negative
  • Carbohydrate antigen 19-9
  • Prognosis
  • Resection