title: Serum alpha-fetoprotein level per tumor volume reflects prognosis in patients with hepatocellular carcinoma after curative hepatectomy.
abstract: OBJECTIVE
  The clinical usefulness of alpha-fetoprotein (AFP) in the management of hepatocellular carcinoma (HCC) remains controversial. This study aimed to assess the prognostic reliability of serum AFP levels per tumor volume (AFP/volume) after curative resection.
  
  
  METHODS
  A total of 196 patients with HCC were analyzed with reference to serum AFP levels at diagnosis. Clinicopathological data included presence of cirrhosis, indocyanine green retention rate (ICGR15), tumor size and number of HCCs. Tumor volume for HCCs was calculated preoperatively by Computed tomography volumetry, and AFP/volume was calculated by dividing serum AFP level by tumor volume.
  
  
  RESULTS
  No significant correlation between serum AFP levels and presence of cirrhosis or ICGR15 was observed. A significant correlation existed between serum AFP levels and both size (P=0.001, r=0.276) and number (P=0.023, r=0.186) of HCCs. The 5-year survival rates in patients with low (< 200 ng/mL) and high (> or = 200 ng/mL) serum AFP level were 85.0% and 36.0%, respectively. AFP/volume tended to be negatively associated with survival period (p=0.084, r = -0.346), and a significant negative correlation existed between AFP/volume and disease-free survival period (p=0.001, r = -0.347). Median values of AFP/ volume in patients who displayed recurrence by 1 year and 6 months were 11.51 and 20.05, respectively.
  
  
  CONCLUSIONS
  AFP/volume represents a better prognostic indicator for patients with HCC than serum AFP value alone. In particular, patients with AFP/volume > 20.0 are likely to experience recurrence within 6 months after curative hepatectomy.
authors.affiliation: Department of Gastroenterological Surgery, Dokkyo University School of Medicine, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi 321-0293, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Furihata
authors.forename: Tokihiko
authors.initials: T
authors.lastname: Sawada
authors.forename: Junji
authors.initials: J
authors.lastname: Kita
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Iso
authors.forename: Masato
authors.initials: M
authors.lastname: Kato
authors.forename: Kyu
authors.initials: K
authors.lastname: Rokkaku
authors.forename: Mitsugi
authors.initials: M
authors.lastname: Shimoda
authors.forename: Keiichi
authors.initials: K
authors.lastname: Kubota
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000401:mortality / Q000601:surgery; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood* / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D000509:alpha-Fetoproteins