Clinical relevance of alpha-fetoprotein in determining resection margin for hepatocellular carcinoma

Jin Chiao Lee, Chih Hsien Cheng, Yu Chao Wang, Tsung Han Wu, Chen Fang Lee, Ting Jung Wu, Hong Shiue Chou, Kun Ming Chan, Wei Chen Lee*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

10 Scopus citations

Abstract

Liver resection for hepatocellular carcinoma (HCC) is associated with high recurrence rates. Adequate resection margin which is carried out by surgeons may reduce tumor recurrence. Nevertheless, the margin width remains controversial particularly in cirrhotic patients where optimal parenchymal preservation is necessary. This study aims to find a reference for proposing the resection margin when liver resection is planning. Totally, 534 patients who received liver resection for HCC were included. The clinical profiles of the patients, tumor characteristics and patients' survival were all collected. The patients were classified according to resection margin (<0.5cm, 0.5.0.99cm, and ≥1 cm) and preoperative α-fetoprotein (AFP) levels (<15ng/ml, 15.200ng/ml, and >200ng/ml), then survival was calculated. Most of the patients had hepatitis B (52.4%) and hepatitis C (24.0%) infection. Multivariate analysis showed that narrow resection margin (<0.5cm) (hazard ratio [HR]: 1.323, P=.024), high AFP level (≥15ng/ml) (HR: 1.305, P=.039), major extent of resection (≥3 segments) (HR: 1.507, P=.034), and underlying cirrhosis (HR: 1.404, P=.009) were independent risk factors for disease-free survival. In further survival analysis, resection margin was not significant for disease-free survival if serum AFP levels were <15ng/ml. However, for the patients with AFP level between 15 and 200ng/ml, resection margin ≥0.5cm was significant to improve 5-year disease-free survival from 24.6 months to 38.7 months (P=.040). For the patients with AFP >200ng/ml, resection margin had to be extended to ≥1cm to improve 5-year disease-free survival from 33.9 months to 48.8 months (P=.012). When the patients meeting AFP <15 ng/ml with tumor-free margin, AFP between 15 and 200 ng/ml with margin ≥0.5cm, and AFP level >200 ng/ml with margin ≥1cm were compared, their survival rates were not different. Adequate resection margin can be guided by pre-operative AFP levels. Tumor-free margin is enough for patients with normal AFP level. A resection margin ≥0.5cm is advised for the patients with AFP between 15 and 200ng/ml, and ≥1cmfor the patients with AFP over 200ng/ml.

Original languageEnglish
Article numbere14827
JournalMedicine (United States)
Volume98
Issue number11
DOIs
StatePublished - 01 03 2019

Bibliographical note

Publisher Copyright:
Copyright © 2019 the Author(s).

Keywords

  • hepatocellular carcinoma
  • liver resection
  • resection margin
  • α-fetoprotein

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