title: α-fetoprotein-to-total tumor volume ratio predicts post-operative tumor recurrence in hepatocellular carcinoma.
abstract: OBJECTIVE
  Serum α-fetoprotein (AFP) and total tumor volume (TTV) are important factors linked with post-operative tumor recurrence in hepatocellular carcinoma (HCC) patients. We investigated the role of a new prognostic marker, AFP-to-TTV ratio, in predicting HCC recurrence.
  
  
  METHODS
  A total of 655 HCC patients undergoing resection were analyzed.
  
  
  RESULTS
  In the multivariate logistic model, serum AFP level [odds ratio (OR) 32.459, p = 0.012] and TTV (OR 0.006, p = 0.01) were independently associated with a higher AFT/TTV ratio. The 1-, 3-, and 5-year tumor recurrence rates were 29 %, 55 %, and 68 %, respectively. In the Cox proportional hazards model, alcoholism (hazard ratio [HR], 1.354, p = 0.028), international normalized ratio of prothrombin time ≥1.01 (HR, 1.349, p < 0.001), multiple nodules (HR, 1.381, p = 0.004), main tumor diameter ≥4 cm (HR, 1.535, p = 0.001), macrovascular invasion (HR, 1.362, p = 0.016), and AFP/TTV ratio ≥1.5 (HR, 1.49, p < 0.001) were independently associated with tumor recurrence. In subgroup analysis, a higher AFP/TTV ratio was significantly associated with tumor recurrence in patients characterized by macrovascular invasion, TTV ≥ 40 cm(3), or main tumor diameter ≥4cm (all p = 0.001).
  
  
  CONCLUSIONS
  The AFP/TTV ratio, a newly proposed marker for predicting post-operative tumor recurrence in HCC, is a feasible surrogate and may be useful in selecting super-high-risk patients for tumor recurrence.
authors.affiliation: Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Yun-Hsuan
authors.initials: YH
authors.lastname: Lee
authors.forename: Chia-Yang
authors.initials: CY
authors.lastname: Hsu
authors.forename: Yi-Hsiang
authors.initials: YH
authors.lastname: Huang
authors.forename: Chien-Wei
authors.initials: CW
authors.lastname: Su
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Lin
authors.forename: Cheng-Yuan
authors.initials: CY
authors.lastname: Hsia
authors.forename: Teh-Ia
authors.initials: TI
authors.lastname: Huo
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D047368:Tumor Burden; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D000509:alpha-Fetoproteins