title: Increased alpha-fetoprotein serum level is predictive for survival and recurrence of hepatocellular carcinoma in non-cirrhotic livers.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) may be diagnosed in the absence of cirrhosis. However, little is known about prognostic factors for the survival of HCC patients with a non-cirrhotic liver in the absence of well-established risk factors.
  
  
  METHODS
  Survival rates and risk factors for survival and recurrence were analysed in all patients diagnosed between 2000 and 2010 with HCC in a non-cirrhotic liver and in the absence of well-established risk factors.
  
  
  RESULTS
  Ninety-four patients were analysed. Treatment with curative intent consisted of surgical resection in 43 patients (46%) and radiofrequency ablation in 4 patients (4%). In patients treated with curative intent and alive 30 days after treatment (n = 40), 1- and 5-year overall survival rates were 95 and 51%, respectively. Patients with a high preoperative α-fetoprotein (AFP) serum level, the presence of microvascular invasion in the resected specimen, a complicated postoperative course and a major resection, due to a greater tumour volume, had a significantly worse outcome and a higher recurrence rate. In multivariate analysis, a high AFP serum level at presentation was significantly associated with recurrence and a worse survival.
  
  
  CONCLUSIONS
  HCC presenting in a non-cirrhotic liver in the absence of well-established risk factors has a poor prognosis. Increased AFP serum levels are significantly associated with clinical outcome.
authors.affiliation: Division of Hepatobiliary and Transplantation Surgery, Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands. c.witjes@erasmusmc.nl
authors.forename: Caroline D M
authors.initials: CD
authors.lastname: Witjes
authors.forename: Wojciech G
authors.initials: WG
authors.lastname: Polak
authors.forename: Cornelis
authors.initials: C
authors.lastname: Verhoef
authors.forename: Ferry A L M
authors.initials: FA
authors.lastname: Eskens
authors.forename: Roy S
authors.initials: RS
authors.lastname: Dwarkasing
authors.forename: Joanne
authors.initials: J
authors.lastname: Verheij
authors.forename: Robert A
authors.initials: RA
authors.lastname: de Man
authors.forename: Jan N M
authors.initials: JN
authors.lastname: Ijzermans
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000209:etiology; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult; D000509:alpha-Fetoproteins / Q000378:metabolism*
chemical_list: C097353:AFP protein, human; D000509:alpha-Fetoproteins