title: Role of blood AFP mRNA and tumor grade in the preoperative prognostic evaluation of patients with hepatocellular carcinoma.
abstract: OBJECTIVE
  To explore the potential prognostic role of preoperative tumor grade and blood AFP mRNA in a cohort of patients with hepatocellular carcinoma (HCC) eligible for radical therapies according to a well-defined treatment algorithm not including nodule size and number as absolute selection criteria.
  
  
  METHODS
  Fifty patients with a diagnosis of HCC were prospectively enrolled in the study. Inclusion criteria were: (1) histological assessment of tumor grade by means of percutaneous biopsies; (2) determination of AFP mRNA status in the blood; (3) patient's eligibility for radical therapies.
  
  
  RESULTS
  At preoperative evaluation, 54% of the study group had a well-differentiated HCC, 42% had AFP mRNA in the blood, 40% had a tumor larger than 5 cm and 56% had more than one nodule. Surgery (resection or liver transplantation) was performed in 29 patients, while 21 had percutaneous ablation procedures. After a median follow-up of 28 mo, 12-, 24-, and 36-mo survival rates were 78%, 58%, and 51%, respectively. Surgical therapy, performance status and three tumor-related variables (AFP mRNA, HCC grade and gross vascular invasion) resulted as significant survival predictors at univariate analysis. Nodule size and number did not perform as significant prognosticators. Multivariate study selected only surgical therapy and a biologically early HCC profile (AFP mRNA negative and well-differentiated tumor without gross vascular invasion) as independent survival variables.
  
  
  CONCLUSIONS
  The preoperative determination of tumor grade and blood AFP mRNA status may potentially refine the prognostic evaluation of HCC patients and improve the selection process for radical therapies.
authors.affiliation: Clinica Chirurgica I - Dipartimento di Scienze Chirurgiche e Gastroenterologiche - Università degli Studi di Padova - Via Giustiniani 2, Policlinico III piano, 35128 Padova, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Cillo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Vitale
authors.forename: Filippo
authors.initials: F
authors.lastname: Navaglia
authors.forename: Daniela
authors.initials: D
authors.lastname: Basso
authors.forename: Umberto
authors.initials: U
authors.lastname: Montin
authors.forename: Marco
authors.initials: M
authors.lastname: Bassanello
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Amico
authors.forename: Francesco Antonio
authors.initials: FA
authors.lastname: Ciarleglio
authors.forename: Alberto
authors.initials: A
authors.lastname: Brolese
authors.forename: Giacomo
authors.initials: G
authors.lastname: Zanus
authors.forename: Vito
authors.initials: V
authors.lastname: De Pascale
authors.forename: Mario
authors.initials: M
authors.lastname: Plebani
authors.forename: Davide Francesco
authors.initials: DF
authors.lastname: D'Amico
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate; D000509:alpha-Fetoproteins / Q000235:genetics / Q000378:metabolism*
chemical_list: D000509:alpha-Fetoproteins