@article{c8cd746272094849b4cb08df6a94e38c,
title = "Is inconsistency of α-fetoprotein level a good prognosticator for hepatocellular carcinoma recurrence?",
abstract = "AIM: To identify the clinical outcomes of hepatocellular carcinoma (HCC) patients with inconsistent α-fetoprotein (AFP) levels which were initially high and then low at recurrence. METHODS: We retrospectively included 178 patients who underwent liver resection with high preoperative AFP levels (≥ 200 ng/dL). Sixty-nine HCC patients had recurrence during follow-up and were grouped by their AFP levels at recurrence: group I, AFP ≤ 20 ng/dL (n = 16); group II, AFP 20-200 ng/dL (n = 24); and group III, AFP ≥ 200 ng/dL (n = 29). Their preoperative clinical characteristics, accumulated recurrence rate, and recurrence-to-death survival rate were compared. Three patients, one in each group, underwent liver resection twice for primary and recurrent HCC. AFP immunohistochemistry of primary and recurrent HCC specimens were examined. RESULTS: In this study, 23% of patients demonstrated normal AFP levels at HCC recurrence. The AFP levels in these patients were initially high. There were no significant differences in clinical characteristics between the three groups except for the mean recurrence interval (21.8 ± 14.6, 12.3 ± 7.7, 8.3 ± 6.6 mo, respectively, P <0.001) and survival time (40.2 ± 19.9, 36.1 ± 22.4, 21.9 ± 22.0 mo, respectively, P = 0.013). Tumor size > 5 cm, total bilirubin > 1.2 mg/dL, vessel invasion, Child classification B, group III, and recurrence interval <12 mo, were risk factors for survival rate. Cox regression analysis was performed and vessel invasion, group III, and recurrence interval were independent risk factors. The recurrence interval was significant longer in group I (P <0.001). The recurrence-to-death survival rate was significantly better in group II (P = 0.016). AFP staining was strong in the primary HCC specimens and was reduced at recurrence in group I specimens. CONCLUSION: Patients in group I with inconsistent AFP levels had a longer recurrence interval and worse recurrence-to-death survival rate than those in group II. This clinical presentation may be caused by a delay in the detection of HCC recurrence. {\textcopyright} 2010 Baishideng.",
keywords = "Hepatocellular carcinoma, Inconsistent a-fetoprotein, Outcome, Recurrence, alpha fetoprotein, bilirubin, adult, article, cancer recurrence, cancer survival, controlled study, female, human, immunohistochemistry, liver cell carcinoma, liver resection, major clinical study, male, prognosis, recurrence risk, tumor volume, aged, blood, Carcinoma, Hepatocellular, Liver Neoplasms, metabolism, middle aged, pathology, retrospective study, survival rate, tumor recurrence, Aged, alpha-Fetoproteins, Female, Humans, Male, Middle Aged, Neoplasm Recurrence, Local, Prognosis, Retrospective Studies, Survival Rate",
author = "Chung-Bao Hsieh and Teng-Wei Chen and Chi-Ming Chu and Heng-Cheng Chu and Cheng-Ping Yu and Kuo-Piao Chung",
note = "被引用次數:8 Export Date: 22 March 2016 CODEN: WJGAF 通訊地址: Chung, K.-P.; Graduate Institute of Health Care Organization Administration, National Taiwan University, 635, No. 17, Suchow Rd, Taipei 100, Taiwan; 電子郵件: kpchung@ntu.edu.tw 化學物質/CAS: bilirubin, 18422-02-1, 635-65-4; alpha-Fetoproteins; alpha-Fetoproteins 參考文獻: Chen, D.S., Sung, J.L., Serum alphafetoprotein in hepatocellular carcinoma (1977) Cancer, 40, pp. 779-783; Peng, S.Y., Lai, P.L., Chu, J.S., Lee, P.H., Tsung, P.T., Chen, D.S., Hsu, H.C., Expression and hypomethylation of alpha-fetoprotein gene in unicentric and multicentric human hepatocellular carcinomas (1993) Hepatology, 17, pp. 35-41; Kudo, M., Okanoue, T., Management of hepatocellular carcinoma in Japan: Consensus-based clinical practice manual proposed by the Japan Society of Hepatology (2007) Oncology, 72 (SUPPL 1), pp. 2-15; Bruix, J., Sherman, M., Management of hepatocellular carcinoma (2005) Hepatology, 42, pp. 1208-1236; Peng, S.Y., Chen, W.J., Lai, P.L., Jeng, Y.M., Sheu, J.C., Hsu, H.C., High alpha-fetoprotein level correlates with high stage, early recurrence and poor prognosis of hepatocellular carcinoma: Significance of hepatitis virus infection, age, p53 and betacatenin mutations (2004) Int J Cancer, 112, pp. 44-50; Tangkijvanich, P., Anukulkarnkusol, N., Suwangool, P., Lertmaharit, S., Hanvivatvong, O., Kullavanijaya, P., Poovorawan, Y., Clinical characteristics and prognosis of hepatocellular carcinoma: Analysis based on serum alpha-fetoprotein levels (2000) J Clin Gastroenterol, 31, pp. 302-308; Soresi, M., Magliarisi, C., Campagna, P., Leto, G., Bonfissuto, G., Riili, A., Carroccio, A., Montalto, G., Usefulness of alpha-fetoprotein in the diagnosis of hepatocellular carcinoma (2003) Anticancer Res, 23, pp. 1747-1753; Farinati, F., Marino, D., De Giorgio, M., Baldan, A., Cantarini, M., Cursaro, C., Rapaccini, G., Trevisani, F., Diagnostic and prognostic role of alpha-fetoprotein in hepatocellular carcinoma: Both or neither? (2006) Am J Gastroenterol, 101, pp. 524-532; Poon, R.T., Fan, S.T., Lo, C.M., Liu, C.L., Wong, J., Intrahepatic re- currence after curative resection of hepatocellular carcinoma: Long-term results of treatment and prognostic factors (1999) Ann Surg, 229, pp. 216-222; Choi, G.H., Kim, D.H., Kang, C.M., Kim, K.S., Choi, J.S., Lee, W.J., Kim, B.R., Prognostic factors and optimal treatment strategy for intrahepatic nodular recurrence after curative resection of hepatocellular carcinoma (2008) Ann Surg Oncol, 15, pp. 618-629; Choi, D., Lim, H.K., Rhim, H., Kim, Y.S., Yoo, B.C., Paik, S.W., Joh, J.W., Park, C.K., Percutaneous radiofrequency ablation for recurrent hepatocellular carcinoma after hepatectomy: Longterm results and prognostic factors (2007) Ann Surg Oncol, 14, pp. 2319-2329; Zhou, L., Liu, J., Luo, F., Serum tumor markers for detection of hepatocellular carcinoma (2006) World J Gastroenterol, 12, pp. 1175-1181; Chen, J.G., Parkin, D.M., Chen, Q.G., Lu, J.H., Shen, Q.J., Zhang, B.C., Zhu, Y.R., Screening for liver cancer: Results of a randomised controlled trial in Qidong, China (2003) J Med Screen, 10, pp. 204-209; Wong, L.L., Limm, W.M., Severino, R., Wong, L.M., Improved survival with screening for hepatocellular carcinoma (2000) Liver Transpl, 6, pp. 320-325; NCCN Clinical Practice Guidelines in Oncology Hepatobiliary cancers (Version 1, 2009), , http://www.nccn.org/professionals/physician_gls/PDF/hepatobiliary.pdf, Available from: URL:; Chen, Y.J., Yeh, S.H., Chen, J.T., Wu, C.C., Hsu, M.T., Tsai, S.F., Chen, P.J., Lin, C.H., Chromosomal changes and clonality relationship between primary and recurrent hepatocellular carcinoma (2000) Gastroenterology, 119, pp. 431-440; Chen, P.J., Chen, D.S., Lai, M.Y., Chang, M.H., Huang, G.T., Yang, P.M., Sheu, J.C., Sung, J.L., Clonal origin of recurrent hepatocellular carcinomas (1989) Gastroenterology, 96, pp. 527-529; Ding, S.F., Jalleh, R.P., Wood, C.B., Bowles, L., Delhanty, J.D., Dooley, J., Habib, N.A., Different DNA changes in primary and recurrent hepatocellular carcinoma (1992) Gut, 33, pp. 1433-1435; Okusaka, T., Okada, S., Nose, H., Ishii, H., Nakasuka, H., Nakayama, H., Nagahama, H., Hirohashi, S., The prognosis of patients with hepatocellular carcinoma of multicentric origin (1996) Hepatogastroenterology, 43, pp. 919-925; Furihata, T., Sawada, T., Kita, J., Iso, Y., Kato, M., Rokkaku, K., Shimoda, M., Kubota, K., Serum alpha-fetoprotein level per tumor volume reflects prognosis in patients with hepatocellular carcinoma after curative hepatectomy (2008) Hepatogastroenterology, 55, pp. 1705-1709; Shirabe, K., Takenaka, K., Gion, T., Shimada, M., Fujiwara, Y., Sugimachi, K., Significance of alpha-fetoprotein levels for detection of early recurrence of hepatocellular carcinoma after hepatic resection (1997) J Surg Oncol, 64, pp. 143-146",
year = "2010",
doi = "10.3748/wjg.v16.i24.3049",
language = "English",
volume = "16",
pages = "3049--3055",
journal = "World Journal of Gastroenterology",
issn = "1007-9327",
publisher = "WJG Press",
number = "24",
}