Does very high alpha-fetoprotein affect very early hepatocellular carcinoma receiving hepatectomy?

Background: Following liver resection (LR), recurrence is critical to the prognosis of hepatocellular carcinoma (HCC). A higher level of alpha-fetoprotein (AFP) is typically associated with poor prognosis and recurrence concerns. Specifically, we attempted to determine whether high AFP (> 1,000ng/ml) and other potentially relevant factors affect survivals of patients with BCLC stage 0 HCC after LR.

Methods: This retrospective study focused on 223 patients who received LR for stage 0 HCC of BCLC between 2004 and 2012. In patients with a low AFP (n = 200) and a high AFP (n = 23), we conducted chi-squares, independent t-test, Cox regression, and Kaplan-Meier survival analyses to investigate the relationship between clinicopathologic variables and outcomes.

Results: The long-term disease-free survival (DFS) (p = 0.799) and the overall survival (OS) (p = 0.942) between the low and high AFP groups were comparable. The two groups' clinicopathologic features-tumor size, presence of a tumor capsule, cirrhosis, histology activity index (HAI), and microvascular invasion-appear to be similar. Additionally, we observed significant associations between HCC recurrence and ICG R15, HAI score, and cirrhosis, but not AFP.

Conclusions: In stage 0 HCC, the consideration of curative-intent therapy in these patients should begin as soon as possible, irrespective of AFP levels.