Prognostic Significance of Preoperative Serum Alphafetoprotein in Hepatocellular Carcinoma and Correlation with Clinicopathological Factors: a Single-center Experience from China

Objectives: To investigate the prognosis significance of preoperative serum alpha-fetoprotein (AFP) andthe correlation with clinicopathological factors of hepatocellular carcinoma (HCC) patients who underwenthepatectomy. Materials and
Methods: Clinicopathological data of retrospective analysis were collected for251 HCC patients undergoing hepatectomy in this study. According to preoperative AFP level, patients werecategorized into AFP-negative (0-20ng/mL) and AFP-positive (>20 ng/mL) groups for Kaplan-Meier analysisand Cox proportional hazard regression modeling.
Results: The results demonstrated that increased AFPwas associated with longer prothrombin time (PTs), liver capsule invasion, low grade differentiation, and lateBarcelona Clinic Liver Center (BCLC) stage. Moreover, the female patients had a greater prevalence of increasedpreoperative AFP than male patients [284.8 (3.975-3167.5) vs (3.653-140.65); Z-2.895, p=0.004]. The 1-, 3-, and5-year recurrence-free survival (RFS) rates were 78.1, 57.5, and 40.6 % in the AFP-negative group and 61.8,37.7, and 31.4 %, respectively, in the AFP-positive group (log-rank test 8.312, p=0.004). The 1-, 3-, and 5-yearoverall survival (OS) rates were 94.4, 83.8, and 62.3% in the AFP-negative group and 87.2, 60.0, and 36.7%,respectively, in the AFP-positive group. The difference was statistically significant (log-rank test, 16.884, p=0.000).Cox proportional-hazards model identified preoperative AFP to be an independent prognostic predictor of overallsurvival.
Conclusions: Preoperative serum AFP is an independent predictor of prognosis among HCC patientsfollowing surgical resection. Female patients have a higher preoperative AFP than their male counterparts.