The prognostic correlation of AFP level at diagnosis with pathological grade, progression, and survival of patients with hepatocellular carcinoma

Abstract

The purpose of this study was to conduct a comprehensive study of the clinical correlation between the alpha-fetoprotein (AFP) level at diagnosis and pathological grades, progression, and survival of patients with hepatocellular carcinoma (HCC). A total of 78,743 patients in Surveillance, Epidemiology, and End Results Program (SEER)-registered HCC was analyzed. The AFP test results for patients with HCC were mainly recorded as AFP-negative and AFP-positive. Logistic regression analysis revealed that the AFP level at diagnosis was an independent risk factor of pathological grade (odds ratio [OR], 2.559; 95% confidence interval [CI], 2.075-3.157; P < 0.001), TNM-7 stage (OR, 2.794; CI, 2.407-3.242; P < 0.001), and tumor size (OR, 1.748; 95% CI, 1.574-1.941; P < 0.001). Multivariable Cox regression analyses identified AFP level as an independent predictor of survival risk of patients with HCC who did not undergo surgery (hazard ratio [HR], 1.660; 95% CI, 1.534-1.797; P < 0.001), and those who underwent surgery (HR, 1.534; 95% CI, 1.348-1.745; P < 0.001). The AFP level at diagnosis was an independent risk predictor associated with pathological grade, progression, and survival. Further, surgery may not significantly reverse the adverse effects of AFP-positive compared with AFP-negative.

Figure 1

CONSORT diagram. Patients with HCC and the required clinical data between 1988 and 2013 were selected from the cancer registries of the Surveillance, Epidemiology, and End Results Program.

Figure 2

Survival curves based on Kaplan-Meier analysis according to AFP level. Survival curves based on Kaplan–Meier analysis that compare the association of “negative-AFP” and “positive-AFP” with HCC cause-specific survival of (A) patients who had not undergone surgery, (B) patients for whom surgery was recommended but not performed, and (C) patients who had undergone surgery.

Figure 3

Survival curves generated using Cox models according to AFP level. Survival curves generated using Cox models that compare the association of “negative-AFP” and “positive-AFP” with hepatocellular carcinoma-specific survival of (A) patients who had not undergone surgery, (B) patients for whom surgery was recommended but not performed, and (C) patients who had undergone surgery.