Does the preoperative alpha‐fetoprotein predict the recurrence and mortality after hepatectomy for hepatocellular carcinoma without macrovascular invasion in patients with normal liver function?

<jats:sec><jats:title>Aim</jats:title><jats:p>It has been highly controversial whether elevated serum α‐fetoprotein (<jats:styled-content style="fixed-case">AFP</jats:styled-content>) level before hepatectomy predicts recurrence and mortality of patients with hepatocellular carcinoma (<jats:styled-content style="fixed-case">HCC</jats:styled-content>) or not. This study is to identify whether the index predicts recurrence and mortality after hepatectomy in <jats:styled-content style="fixed-case">HCC</jats:styled-content>.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Of 568 consecutive patients, 342 with normal liver function (<jats:styled-content style="fixed-case">C</jats:styled-content>hild–<jats:styled-content style="fixed-case">P</jats:styled-content>ugh score, 5) and no macrovascular invasion were enrolled between <jats:styled-content style="fixed-case">A</jats:styled-content>pril 2000 and <jats:styled-content style="fixed-case">M</jats:styled-content>arch 2013. Multivariate analysis was performed to identify risk factors for disease‐free survival (<jats:styled-content style="fixed-case">DFS</jats:styled-content>) and overall survival (<jats:styled-content style="fixed-case">OS</jats:styled-content>).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In multivariate analysis, the elevated serum <jats:styled-content style="fixed-case">AFP</jats:styled-content> level was an independent risk factor for <jats:styled-content style="fixed-case">DFS</jats:styled-content> (hazard ratio [<jats:styled-content style="fixed-case">HR</jats:styled-content>], 1.9; <jats:italic>P</jats:italic> < 0.0001) and <jats:styled-content style="fixed-case">OS</jats:styled-content> (<jats:styled-content style="fixed-case">HR</jats:styled-content>, 2.0; <jats:italic>P</jats:italic> < 0.0001). Histological hepatic venous tumor thrombus was also an independent risk factor for <jats:styled-content style="fixed-case">DFS</jats:styled-content> (<jats:styled-content style="fixed-case">HR</jats:styled-content>, 2.6; <jats:italic>P</jats:italic> < 0.0001) and <jats:styled-content style="fixed-case">OS</jats:styled-content> (<jats:styled-content style="fixed-case">HR</jats:styled-content>, 2.5; <jats:italic>P</jats:italic> = 0.001). Anatomical resection decreases the risk factor for recurrence after hepatectomy (<jats:styled-content style="fixed-case">HR</jats:styled-content>, 0.6; <jats:italic>P</jats:italic> = 0.003), though it did not decrease the risk for <jats:styled-content style="fixed-case">OS</jats:styled-content> (<jats:italic>P</jats:italic> = 0.3). At 5 years, <jats:styled-content style="fixed-case">DFS</jats:styled-content> rates were 42% and 21% (<jats:italic>P</jats:italic> < 0.0001) and <jats:styled-content style="fixed-case">OS</jats:styled-content> rates were 75% and 46% among patients with low and high <jats:styled-content style="fixed-case">AFP</jats:styled-content> levels, respectively (<jats:italic>P</jats:italic> < 0.0001). The area under the receiver–operator curves (<jats:styled-content style="fixed-case">AUROC</jats:styled-content>) of serum <jats:styled-content style="fixed-case">AFP</jats:styled-content> and des‐γ‐carboxy prothrombin were 0.65 and 0.58 for <jats:styled-content style="fixed-case">DFS</jats:styled-content> and 0.65 and 0.57 for <jats:styled-content style="fixed-case">OS</jats:styled-content>, respectively. Tumor size was the best predictor of microvascular invasion (<jats:styled-content style="fixed-case">AUROC</jats:styled-content>, 0.70, <jats:italic>P</jats:italic> < 0.0001).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Serum <jats:styled-content style="fixed-case">AFP</jats:styled-content> was a highly reliable index for <jats:styled-content style="fixed-case">DFS</jats:styled-content> and <jats:styled-content style="fixed-case">OS</jats:styled-content>.</jats:p></jats:sec>