title: Does the preoperative alpha-fetoprotein predict the recurrence and mortality after hepatectomy for hepatocellular carcinoma without macrovascular invasion in patients with normal liver function?
abstract: OBJECTIVE
  It has been highly controversial whether elevated serum α-fetoprotein (AFP) level before hepatectomy predicts recurrence and mortality of patients with hepatocellular carcinoma (HCC) or not. This study is to identify whether the index predicts recurrence and mortality after hepatectomy in HCC.
  
  
  METHODS
  Of 568 consecutive patients, 342 with normal liver function (Child-Pugh score, 5) and no macrovascular invasion were enrolled between April 2000 and March 2013. Multivariate analysis was performed to identify risk factors for disease-free survival (DFS) and overall survival (OS).
  
  
  RESULTS
  In multivariate analysis, the elevated serum AFP level was an independent risk factor for DFS (hazard ratio [HR], 1.9; P < 0.0001) and OS (HR, 2.0; P < 0.0001). Histological hepatic venous tumor thrombus was also an independent risk factor for DFS (HR, 2.6; P < 0.0001) and OS (HR, 2.5; P = 0.001). Anatomical resection decreases the risk factor for recurrence after hepatectomy (HR, 0.6; P = 0.003), though it did not decrease the risk for OS (P = 0.3). At 5 years, DFS rates were 42% and 21% (P < 0.0001) and OS rates were 75% and 46% among patients with low and high AFP levels, respectively (P < 0.0001). The area under the receiver-operator curves (AUROC) of serum AFP and des-γ-carboxy prothrombin were 0.65 and 0.58 for DFS and 0.65 and 0.57 for OS, respectively. Tumor size was the best predictor of microvascular invasion (AUROC, 0.70, P < 0.0001).
  
  
  CONCLUSIONS
  Serum AFP was a highly reliable index for DFS and OS.
authors.affiliation: Department of Hepatobiliary Pancreatic Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kudo
authors.forename: Satoshi
authors.initials: S
authors.lastname: Matsumura
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ban
authors.forename: Takumi
authors.initials: T
authors.lastname: Irie
authors.forename: Takanori
authors.initials: T
authors.lastname: Ochiai
authors.forename: Shinji
authors.initials: S
authors.lastname: Tanaka
authors.forename: Shigeki
authors.initials: S
authors.lastname: Arii
authors.forename: Minoru
authors.initials: M
authors.lastname: Tanabe
keywords: alpha-fetoprotein; liver function; microvascular invasion; normal liver function; prognosis