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Ann Surg Oncol. <http://www.ncbi.nlm.nih.gov/pubmed/24232510> 2013 Nov
14. [Epub ahead of print]
Assessing Prognostic Significance of Preoperative Alpha-Fetoprotein in
Hepatitis B-Associated Hepatocellular Carcinoma: Normal is not the New
Normal.
Blank S
<http://cirrus.mail-list.com/hepatitis-b/99168469.html>, Wang Q
<http://cirrus.mail-list.com/hepatitis-b/25989089.html>, Fiel MI
<http://cirrus.mail-list.com/hepatitis-b/27445181.html>, Luan W
<http://cirrus.mail-list.com/hepatitis-b/79562610.html>, Kim KW
<http://cirrus.mail-list.com/hepatitis-b/20641433.html>, Kadri H
<http://cirrus.mail-list.com/hepatitis-b/98573824.html>, Mandeli J
<http://cirrus.mail-list.com/hepatitis-b/60918996.html>, Hiotis SP
<http://cirrus.mail-list.com/hepatitis-b/96724771.html>.
Source: http://www.ncbi.nlm.nih.gov/pubmed/24232510
Division of Surgical Oncology, Department of Surgery, The Mount Sinai
Medical Center, Mount Sinai School of Medicine, New York, NY, USA.
Abstract
BACKGROUND:
Hepatitis B(HBV)-associated hepatocellular carcinoma (HCC) is often
associated with alpha-fetoprotein (AFP) production. Although serum AFP
has been demonstrated to be a prognostic factor for patient survival,
optimal cutoff levels remain unclear.
METHODS:
Patients with HBV-associated HCC treated by primary liver resection were
prospectively followed at a single institution between 1995 and 2008. AFP
level was categorized into quintiles for Kaplan-Meier analysis and
multivariable Cox proportional hazards regression models.
RESULTS:
Best 5-year survival after surgery was observed for patients with AFP in
the first quintile (1.4-4.1 ng/mL), with progressively worse outcomes for
patients in each increasing quintile. AFP was associated with overall
survival (HR = 1.61; 95 % CI 1.30-1.98), disease-free survival (HR =
1.26; 95 % CI 1.10-1.44), and 2-year recurrence (HR = 1.30; 95 % CI
1.07-1.57) in multivariate analysis. Noncirrhotic patients (Ishak 1-5)
with AFP in quintile 1 had 94 % 5-year survival, compared with 0 %
survival for patients with AFP in quintile 5 (2,332.7-327,560.0 ng/mL)
and Ishak stage 6 cirrhosis.
CONCLUSIONS:
Preoperative serum AFP is an independent predictor of prognosis among
HBV-HCC patients following surgical resection. Categorizing AFP into
quintiles creates the opportunity to observe differences in outcomes even
at low serum levels within the normal range. Additionally, combining AFP
quintiles and fibrosis staging provides a predictive model of prognosis
for HCC. Thus, even small differences in AFP within the normal range may
impact prognosis and disease progression for HBV-HCC.
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