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https://wslhd.intersearch.com.au/wslhdjspui/handle/1/6772
Title: | Serum alpha-Fetoprotein Levels at Time of Recurrence Predict Post-Recurrence Outcomes Following Resection of Hepatocellular Carcinoma |
Authors: | Tsilimigras, D. I.;Moris, D.;Hyer, J. M.;Bagante, F.;Ratti, F.;Marques, H. P.;Soubrane, O.;Lam, Vincent W. T.;Poultsides, G. A.;Popescu, I.;Alexandrescu, S.;Martel, G.;Workneh, A.;Guglielmi, A.;Hugh, T.;Aldrighetti, L.;Endo, I.;Pawlik, T. M. |
WSLHD Author: | Lam, Vincent W. T. |
Issue Date: | 2021 |
Citation: | Annals of Surgical Oncology 28(12):7673-7683, 2021 |
Abstract: | INTRODUCTION: Although preoperative alpha-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 HCC recurrence were examined. RESULTS: Among 852 patients who underwent resection of HCC, 307 (36.0%) individuals developed a recurrence. The median rAFP level was 8 ng/mL (interquartile range 3-100). Among the 307 patients who developed recurrence, 3-year post-recurrence survival was 48.5%. Patients with rAFP > 10 ng/mL had worse 3-year post-recurrence survival compared with individuals with rAFP < 10 ng/mL (28.7% vs. 65.5%, p < 0.001). rAFP correlated with survival among patients who had early (3-year survival; rAFP > 10 vs. < 10 ng/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. < 10 ng/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 > 10 ng/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. |
URI: | https://wslhd.intersearch.com.au/wslhdjspui/handle/1/6772 |
DOI: | https://dx.doi.org/10.1245/s10434-021-09977-x |
Journal: | Annals of Surgical Oncology |
Type: | Journal Article |
Department: | Surgery |
Facility: | Westmead |
Keywords: | Carcinoma, Hepatocellular Liver Neoplasms Neoplasm Recurrence, Local alpha-Fetoproteins |
Appears in Collections: | Westmead Hospital 2019 - 2024 |
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