Serum α-fetoprotein level as a biomarker for early recurrence after R0 resection in primary hepatocellular carcinoma

Objectives:To investigate the impact of serumα-fetoprotein(AFP)levels on survival and early recurrence after R0 resection in primary hepatocellular carcinoma(HCC).Methods:We retrospectively analyzed clinical data of 582 patients with primary HCC(male:488,female:94;mean age:51 years[age range,31-73 years])who underwent R0 resection between January 1997 and December 2009.The 1-,3-,and 5-year overall survival(OS)rates and the clinico-pathological factors between the AFP-negative and AFP-positive groups were compared.Risk fac-tors of early recurrence in the AFP-positive group were further analyzed.Results:Age and histological differentiation were significantly lower in the AFP-positive group than in AFP-negative group(χ^(2)=11.004,32.293;P=0.000).In the AFP-positive group,serumγ-glutamyl transferase levels,tumor diameters,TNM stage,and early recurrence rate were higher(χ^(2)=9.814 to 14.009,P<0.05),whereas the proportion of solitary HCC was lower(χ^(2)=8.509,P=0.004).The 1-,3-,and 5-year OS rates in the AFP-positive group were 80.5%,66.9%,and 40.2%,respectively,and those in the AFP-negative group were 89.2%,79.9%,and 50.3%,respec-tively(χ^(2)=11.884,P=0.001).The 1-,3-,and 5-year disease-free survival rates were 65.6%,48.5%,29.6%in the AFP-positive group and 81.7%,63.9%,42.1%in the AFP-negative group respectively(χ^(2)=15.574,P=0.000).The median OS times of early recurrence and non-early recurrence were 10 and 62 months,respectively(χ^(2)=45.013,P=0.000),and their median survival times from recurrence to death were 6 and 14 months,respectively(χ^(2)=40.581,P=0.000).Multiple-factor analysis suggested non-solitary HCC and low histological differentiation are independent risk factors influencing early recurrence of HCC.Conclusion:Elevated preoperative serum AFP levels were indicative of early HCC recurrence.