Association of postoperative biomarker response with recurrence and survival in patients with hepatocellular carcinoma and high alpha-fetoprotein expressions (> 400 ng/mL)

Introduction High alpha-fetoprotein (AFP) expressions (> 400 ng/mL) are associated with poor oncological characteristics for hepatocellular carcinoma (HCC). However, prognosis after liver resection for high-AFP HCC is poorly studied. To investigate long-term recurrence and survival after hepatectomy for high-AFP HCC, and to identify the predictive value of postoperative incomplete biomarker response (IBR) on overall survival (OS) and recurrence-free survival (RFS). Methods Patients undergoing curative resection for high-AFP HCC were analyzed. According to the decline magnitude of serum AFP as measured at first follow-up (4-6 weeks after surgery), all patients were divided into the complete biomarker response (CBR) and IBR groups. Characteristics, recurrence, and survival rates were compared. Results Among 549 patients, the overall and early recurrence rates in patients with IBR were significantly higher than patients with CBR (97.8% vs. 56.4%, and 92.5% vs. 33.3%, both p < 0.001). On multivariate analysis, postoperative IBR was the strongest risk factor with the highest hazard ratio in predicting poor OS (2.97; 2.49-3.45; p < 0.001) and RFS (4.29; 3.31-5.55; p < 0.001). Conclusions Postoperative biomarker response of serum AFP can be used in predicting recurrence and survival for high-AFP HCC patients. Once postoperative IBR was identified at first follow-up, subsequent enhanced recurrence surveillance and available treatments against recurrence should actively be considered.