title: Changes in serum alpha fetoprotein in patients with recurrent hepatocellular carcinoma following hepatectomy.
abstract: OBJECTIVE
  To study the change in serum alpha fetoprotein (AFP) of patients with recurrent hepatocellular carcinoma (HCC) after curative resection and to analyze its effect on the survival.
  
  
  METHODS
  We prospectively collected 981 consecutive patients with post-resectional recurrent HCC between 2005 and 2010 at the Eastern Hepatobiliary Surgery Hospital. According to the change of AFP from the initial stage to recurrent stage, the patients were divided into stable-L (20 ng/mL to 20 ng/mL, n = 296), stable-M (20-400 ng/mL to 20-400 ng/mL, n = 102), stable-H (400 ng/mL to 400 ng/mL, n = 212), decreasing (n = 287), and increasing (n = 84) groups. The overall survival (OS) and recurrence to death survival (RTDS) were analyzed using Kaplan-Meier method. Multivariate analysis was performed by Cox proportional hazards regression.
  
  
  RESULTS
  The stable-H/increasing and stable-L/decreasing groups had the lowest and highest 5-year OS and RTDS rates (10.8%/18.8% vs 56.3%/55.0%; 3.4%/5.1% vs 37.7%/33.2%; both P < 0.001), while the stable-M group had the lower rates, which were 29.8% and 23.6% (for OS and RTDS: vs stable-L, P < 0.001 and 0.002; vs deceasing, P = 0.001 and 0.012; vs increasing, P = 0.113 and 0.011; vs stable-H, both P < 0.001). Cox regression analysis showed that AFP inconsistency was an independent factor affecting RTDS (decreasing vs stable-L, hazard ratio: 1.10, 95% confidence interval: 0.79-1.54, P = 0.575; increasing vs stable-L, 2.93, 2.06-4.16, P < 0.001).
  
  
  CONCLUSIONS
  The AFP inconsistency was an important prognostic factor for recurrent HCC.
authors: Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.|Department of Interventional Radiology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
authors: Guanghua
authors: G
authors: Liu
authors: Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
authors: Kui
authors: K
authors: Wang
authors: Department of Clinical Database, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
authors: Jun
authors: J
authors: Li
authors: Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
authors: Yong
authors: Y
authors: Xia
authors: Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
authors: Lihua
authors: L
authors: Lu
authors: Department of Clinical Database, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
authors: Xuying
authors: X
authors: Wan
authors: Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
authors: Zhenlin
authors: Z
authors: Yan
authors: Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
authors: Lehua
authors: L
authors: Shi
authors: Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.|Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
authors: Wan Yee
authors: WY
authors: Lau
authors: Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
authors: Mengchao
authors: M
authors: Wu
authors: Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
authors: Feng
authors: F
authors: Shen
mesh_terms: D000328:Adult; D014408:Biomarkers, Tumor / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D014408:Biomarkers, Tumor; D000509:alpha-Fetoproteins
keywords: alpha fetoprotein; hepatectomy; hepatocellular carcinoma; recurrence