title: Combined AFP-CRUT with microvascular invasion accurately predicts mortality risk in patients with hepatocellular carcinoma following curative liver resection.
abstract: OBJECTIVE
  To establish and validate an equation of α-fetoprotein (AFP) change rate over unit time (AFP-CRUT) as a potential predictor of survival after resection in patients with hepatocellular carcinoma (HCC).
  
  
  METHODS
  The AFP-CRUT was constructed based on dynamic variation in AFP over time and then categorized into quintiles. The area under the receiver operating characteristic (ROC) curve showed the performance for survival prediction.
  
  
  RESULTS
  As independent risk factors associated with mortality, microvascular invasion (MVI) (p = 0.003) and AFP-CRUT quintiles (p = 0.048) were combined to enhance the predictive effect. The highest 5-year overall survival rate following curative liver resection (93%) was observed in patients with MVI absent and AFP-CRUT in quintile 1 (49.64 to 209.61). In contrast, the lowest 5-year overall survival (7%) was obtained in quintile 5 (-469.29 to 6.45) with MVI present. In validation cohorts at both 12 and 24 months, AFP-CRUT performed well as a potential prognostic biomarker.
  
  
  CONCLUSIONS
  Combining AFP-CRUT quintiles with MVI may predict significantly improved outcomes and enhance the predictive power for patient responses to therapeutic intervention.
authors.affiliation: Department of Infection and Liver Diseases, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Gui-Qian
authors.initials: GQ
authors.lastname: Huang
authors.forename: Gui-Qi
authors.initials: GQ
authors.lastname: Zhu
authors.forename: Sha
authors.initials: S
authors.lastname: Huang
authors.forename: Jie
authors.initials: J
authors.lastname: You
authors.forename: Ke-Qing
authors.initials: KQ
authors.lastname: Shi
authors.forename: Bin
authors.initials: B
authors.lastname: Hu
authors.forename: Lu-Yi
authors.initials: LY
authors.lastname: Ruan
authors.forename: Meng-Tao
authors.initials: MT
authors.lastname: Zhou
authors.forename: Martin
authors.initials: M
authors.lastname: Braddock
authors.forename: Ming-Hua
authors.initials: MH
authors.lastname: Zheng
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008297:Male; D055641:Mathematical Concepts; D055806:Microvessels / Q000473:pathology; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests; D012372:ROC Curve; D015996:Survival Rate; D000509:alpha-Fetoproteins / Q000378:metabolism*
chemical_list: D000509:alpha-Fetoproteins
keywords: curative liver resection; dynamic parameter; hepatocellular carcinoma; microvascular invasion; overall survival; α-fetoprotein