Serum α-Fetoprotein Levels at Time of Recurrence Predict Post-Recurrence Outcomes Following Resection of Hepatocellular Carcinoma
| Autor: | Dimitrios Moris, Itaru Endo, J. Madison Hyer, Francesca Ratti, Luca Aldrighetti, Olivier Soubrane, Sorin Alexandrescu, Aklile Workneh, Timothy M. Pawlik, Thomas J. Hugh, Irinel Popescu, Guillaume Martel, Fabio Bagante, George A. Poultsides, Diamantis I. Tsilimigras, Hugo Marques, Vincent Lam, Alfredo Guglielmi |
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| Přispěvatelé: | Tsilimigras, D. I., Moris, D., Hyer, J. M., Bagante, F., Ratti, F., Marques, H. P., Soubrane, O., Lam, V., Poultsides, G. A., Popescu, I., Alexandrescu, S., Martel, G., Workneh, A., Guglielmi, A., Hugh, T., Aldrighetti, L., Endo, I., Pawlik, T. M. |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Carcinoma Hepatocellular 030230 surgery Gastroenterology Resection 03 medical and health sciences 0302 clinical medicine Text mining Surgical oncology Interquartile range Serum α-Fetoprotein Levels Internal medicine medicine Humans Tumor marker business.industry Carcinoma Liver Neoplasms Hazard ratio Hepatocellular Hepatocellular Carcinoma Prognosis medicine.disease digestive system diseases Confidence interval HCC CHBPT Neoplasm Recurrence Local Oncology 030220 oncology & carcinogenesis Hepatocellular carcinoma Surgery alpha-Fetoproteins Neoplasm Recurrence Local business |
| Zdroj: | Annals of Surgical Oncology. 28:7673-7683 |
| ISSN: | 1534-4681 1068-9265 |
| DOI: | 10.1245/s10434-021-09977-x |
| Popis: | Introduction: Although preoperative α-fetoprotein (AFP) has been recognized as an important tumor marker among patients with hepatocellular carcinoma (HCC), the predictive value of AFP levels at the time of recurrence (rAFP) on post-recurrence outcomes has not been well examined. Methods: Patients undergoing curative-intent resection of HCC between 2000 and 2017 were identified using a multi-institutional database. The impact of rAFP on post-recurrence survival, as well as the impact of rAFP relative to the timing and treatment of HCCrecurrence wereexamined. Results: Among 852 patients who underwent resection of HCC, 307 (36.0%) individuals developed a recurrence. The median rAFP level was 8ng/mL (interquartile range 3–100). Among the 307 patients who developed recurrence, 3-year post-recurrence survival was 48.5%. Patients with rAFP > 10ng/mL had worse 3-year post-recurrence survival compared with individuals with rAFP < 10ng/mL (28.7% vs. 65.5%, p < 0.001). rAFP correlated with survival among patients who had early (3-year survival; rAFP > 10 vs. < 10ng/mL: 30.1% vs. 60.2%, p < 0.001) or late (18.0% vs. 78.7%, p = 0.03) recurrence. Furthermore, rAFP levels predicted 3-year post-recurrence survival among patients independent of the therapeutic modality used to treat the recurrent HCC (rAFP > 10 vs. < 10ng/mL; ablation: 41.1% vs. 76.0%; intra-arterial therapy: 12.9% vs. 46.1%; resection: 37.5% vs. 100%; salvage transplantation: 60% vs. 100%; all p < 0.05). After adjusting for competing risk factors, patients with rAFP > 10ng/mL had a twofold higher hazard of death in the post-recurrence setting (hazard ratio 1.96, 95% confidence interval 1.26–3.04). Conclusion: AFP levels at the time of recurrence following resection of HCC predicted post-recurrence survival independent of the secondary treatment modality used. Evaluating AFP levels at the time of recurrence can help inform post-recurrence risk stratification of patients with recurrent HCC. |
| Databáze: | OpenAIRE |
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