Value of alpha-fetoprotein in hepatocellular carcinoma
Wei‐Chen Lee
Abstract
In July issue of this Journal, Chan et al. published a paper focusing on prognostic value of pre-operative alphafetoprotein (AFP) level in the patients receiving hepatectomy for hepatocellular carcinoma (HCC) (1). They collected 1,182 patients who had curative hepatectomy for HCC. The patients were divided into 3 groups: AFP <20, 20-400 and >400 ng/mL. The patients with AFP >400 ng/mL were younger than the patients with AFP <20 or 20-400 ng/mL. Because they were young, the patients with AFP >400 ng/mL have less incidence of comorbid diseases. The patients with AFP >400 ng/mL had larger tumors and up to 65.9% of the patients had vascular invasion. The 5-year overall and disease-free survival were significantly lower than the patients with AFP <20 ng/mL and the patients with AFP between 20 to 400 ng/mL. Dr. Chan also used receiver operating characteristic curve to search the optimal cut off value of AFP for disease-free and overall survival. They found that the survival rate was compatible to one stage up for disease-free survival if AFP was >9,000 ng/mL and one stage up for overall survival if AFP was >14,000 ng/mL. Finally, they claimed that pre-operative AFP level was a significantly prognostic factor to predict survival. High level of AFP >9,000 and >14,000 ng/mL warrant an up stage of the diseases for disease-free and overall survival, respectively.