Incorporation of alpha-fetoprotein(AFP) into subclassification of BCLC C stage hepatocellular carcinoma according to a 5-year survival analysis based on the SEER database.
OBJECTIVE
To evaluate the effect of serum alpha-fetoprotein(AFP) on prognosis of patients with hepatocellular carcinoma (HCC) and put forward a proposal to modify BCLC staging system and the recommended treatment of patients with stage C.


RESULTS
AFP positive was an independent poor prognostic factor of HCC. Race, pathological grade, T stage, M stage were also regarded to be significant predicted factors for poorer prognosis. When combining AFP status with AJCC stage, patients with A1 disease had a worse prognosis compared with those with A0 disease within each stage. Patients with A1 disease of each T/N stage had a worse prognosis than patients with A0 disease of the respective stage, and the prognosis of patients with A1 disease with lower T stages was worse or similar to that of patients with A0 disease of higher T stages.


METHODS
We performed a retrospective study of all patients histologically diagnosed HCC from January 1, 2004, through December 31, 2008, from the SEER database.


CONCLUSIONS
AFP can be used as a subclassification index to modify the AJCC staging system of HCC. Since BCLC stage is the most widely used staging system, we recommend routine pre-treatment AFP testing as standard of care in HCC and incorporate AFP status into the BCLC staging system to modify the recommended treatment of patients with stage C.
The Fourth Clinical School of Nanjing Medical University, Nanjing, China.|Department of Radiation Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, Nanjing, China.|Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Nanjing, China.
Nan
N
Zhang
Department of Radiation Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, Nanjing, China.
Jiajia
J
Gu
The Fourth Clinical School of Nanjing Medical University, Nanjing, China.|Department of Radiation Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, Nanjing, China.|Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Nanjing, China.
Li
L
Yin
Department of Radiation Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, Nanjing, China.
Jing
J
Wu
The Fourth Clinical School of Nanjing Medical University, Nanjing, China.|Department of Radiation Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, Nanjing, China.|Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Nanjing, China.
Ming-Yu
MY
Du
Department of Radiation Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, Nanjing, China.|Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Nanjing, China.|Xuzhou Medical University, Xuzhou, China.
Kai
K
Ding
The Fourth Clinical School of Nanjing Medical University, Nanjing, China.|Department of Radiation Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, Nanjing, China.|Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Nanjing, China.
Teng
T
Huang
The Fourth Clinical School of Nanjing Medical University, Nanjing, China.|Department of Radiation Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, Nanjing, China.|Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Nanjing, China.|Xuzhou Medical University, Xuzhou, China.
Xia
X
He
D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D016208:Databases, Factual; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018426:SEER Program; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D000509:alpha-Fetoproteins / Q000032:analysis*
C097353:AFP protein, human; D000509:alpha-Fetoproteins
AFP; BCLC; SEER; hepatocellular carcinoma