TY - JOUR
T1 - Clinical relevance of alpha-fetoprotein in determining resection margin for hepatocellular carcinoma
AU - Lee, Jin Chiao
AU - Cheng, Chih Hsien
AU - Wang, Yu Chao
AU - Wu, Tsung Han
AU - Lee, Chen Fang
AU - Wu, Ting Jung
AU - Chou, Hong Shiue
AU - Chan, Kun Ming
AU - Lee, Wei Chen
N1 - Publisher Copyright:
Copyright © 2019 the Author(s).
PY - 2019/3/1
Y1 - 2019/3/1
N2 - 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.
AB - 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.
KW - hepatocellular carcinoma
KW - liver resection
KW - resection margin
KW - α-fetoprotein
UR - http://www.scopus.com/inward/record.url?scp=85063267621&partnerID=8YFLogxK
U2 - 10.1097/MD.0000000000014827
DO - 10.1097/MD.0000000000014827
M3 - 文章
C2 - 30882667
AN - SCOPUS:85063267621
SN - 0025-7974
VL - 98
JO - Medicine (United States)
JF - Medicine (United States)
IS - 11
M1 - e14827
ER -