733P - 3-months postresection alpha-fetoprotein: an independent prognostic tool in patients with hepatocellular carcinoma on cirrhosis

Date 30 September 2012
Event ESMO Congress 2012
Session Poster presentation II
Topics Biomarkers
Hepatobiliary Cancers
Presenter Marc-Antoine Allard
Authors M. Allard1, A. Sa-Cunha2, E. Vibert3, B. Paule3, G. Pelletier3, M. Sebagh3, C. Guettier3, D. Castaing3, R. Adam3
  • 1AP-HP Hôpital Paul Brousse, F-94800 - Villejuif/FR
  • 2Centre Hépato-biliaire, AP-HP Hôpital Paul Brousse, Villejuif/FR
  • 3Centre Hépato-biliaire, AP-HP Hôpital Paul Brousse, F-94800 - Villejuif/FR

Abstract

Background

Alpha Fetoprotein (AFP) is a major tumor marker in patients with hepatocellular carcinoma (HCC). Our aim was to assess the prognostic value of AFP measured within the 3-months following partial hepatectomy for HCC on cirrhosis.

Methods

All patients treated for HCC on cirrhosis by partial hepatectomy with intention to treat between January 1990 and December 2010 and presenting an elevation of AFP (>15ng/ml) at diagnosis were included in the study. The AFP value within the 90 postoperative days was retrospectively collected and analyzed as a dichotomized variable (normalization or absence of normalization). Performed on the whole study population, Cox proportional hazards models were utilized to assess the impact of postresection AFP normalization on overall survival (OS).

Results

Among 271 patients treated for HCC on cirrhosis by liver resection, 145 (53%) patients presented an elevation of AFP level (>15ng/ml). The AFP value was available within the 90 postoperative days in 96 patients (66%). Missing data were related to the 7 post-operative deaths, the 22 patients lost from follow up, and the 20 patients for which the first post-operative AFP measurement was performed beyond the 90 postoperative days. 5 years-OS after liver resection and median survival were 45% and 54 months in the group with post-resection AFP normalization versus 24% and 23 months in the group without postresection AFP normalization, respectively (P = 0,02). There was a significant decline of disease-free survival in the group without postresection AFP normalization experiencing median survival of 6 months versus 19 months (P < 0,001). At multivariate analysis, postresection AFP normalization within the 90 post-operative days (OR: 2,38; CI: 1,32-4,28; P = 0,004) and microvascular invasion (OR: 4; CI: 2,1-7,6; P < 0,001) were two independent predictors of OS. Interestingly, among patients without AFP normalization, 13 had no vascular invasion but all of them developed further recurrence.

Conclusion

This study emphasizes the role of AFP in the 3-months period following HCC resection on cirrhotic livers, which should be considered more systematically to help postresection management.

Disclosure

All authors have declared no conflicts of interest.