Role of blood AFP mRNA and tumor grade in the preoperative prognostic evaluation of patients with hepatocellular carcinoma.
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.
Cillo
Umberto
U
Clinica Chirurgica I - Dipartimento di Scienze Chirurgiche e Gastroenterologiche - Università degli Studi di Padova - Via Giustiniani 2, Policlinico III piano, 35128 Padova, Italy.
Vitale
Alessandro
A
Navaglia
Filippo
F
Basso
Daniela
D
Montin
Umberto
U
Bassanello
Marco
M
D'Amico
Francesco
F
Ciarleglio
Francesco Antonio
FA
Brolese
Alberto
A
Zanus
Giacomo
G
De Pascale
Vito
V
Plebani
Mario
M
D'Amico
Davide Francesco
DF
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*
D000509:alpha-Fetoproteins