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. 2017 Oct 16:9:503-511.
doi: 10.2147/CMAR.S147097. eCollection 2017.

Extrahepatic metastasis risk of hepatocellular carcinoma based on α-fetoprotein and tumor staging parameters at cross-sectional imaging

Takeshi Yokoo  1 , Amish D Patel  1 , Naama Lev-Cohain  1 , Amit G Singal  2 , Adam C Yopp  3 , Ivan Pedrosa  1
Affiliations

Extrahepatic metastasis risk of hepatocellular carcinoma based on α-fetoprotein and tumor staging parameters at cross-sectional imaging

Takeshi Yokoo et al. Cancer Manag Res. .

Abstract

Background: Extrahepatic metastases have important implications in the clinical management of hepatocellular carcinoma (HCC). The purpose of this study was to validate tumor staging parameters and serum AFP as risk factors of HCC metastasis.

Patients and methods: In this retrospective case-control study, patients with a new diagnosis of HCC (N=236), median age 57 years (range 28-89 years), and male-to-female ratio of 183/53 were divided into a "no-met" group (N=101) without extrahepatic metastasis or a "met" group with extrahepatic metastases (N=135). Metastasis risk factors based on tumor staging parameters (size, number, infiltration, and vascular invasion) and serum AFP level were calculated as odds ratio (OR). Sensitivities of the risk factors as metastasis screening tests were also calculated.

Results: AFP >400 μg/mL, index tumor size >5 cm, and vascular invasion individually had strong association with metastasis, with OR (95% confidence interval) of 11.5 (5.9-22.1), 17.7 (9.0-34.8), and 18.9 (8.2-43.9), respectively, but with moderate sensitivities as metastasis screening tests, with 71.9% (65.7-77.3), 75.6% (69.6-80.7), and 58.5% (52.1-64.7), respectively. Composite multiparametric criteria, eg, a logical union of 1) tumor size outside of Milan criteria, 2) AFP threshold >35 μg/mL, and 3) vascular invasion, had excellent OR up to 55.6 (13.0-237.1) with screening sensitivity 98.5% (95.8-99.6).

Conclusion: Serum AFP, tumor size, and vascular invasion are strongly associated with extrahepatic metastasis of HCC, especially when combined into a multiparametric metastasis prediction criterion.

Keywords: hepatocellular carcinoma; metastasis; risk factor; stage; α-fetoprotein.

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Conflict of interest statement

Disclosure AGS is on the Speakers’ Bureau and a consultant for Bayer. ACY is on the Speakers’ Bureau for Bayer and received research funding from Novartis, Merck, and Peregrine. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flowchart of inclusion and exclusion criteria (white and gray, respectively) with the number of subjects meeting each criterion in parentheses. Abbreviation: HCC, hepatocellular carcinoma.
See this image and copyright information in PMC

References

    1. U.S. Cancer Statistics Working Group [webpage on the Internet] United States Cancer Statistics: 1999–2012 Incidence and Mortality Web-based Report. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2015. [Accessed September 25, 2017]. Available from: http://www.cdc.gov/uscs.
    1. Ryerson AB, Eheman CR, Altekruse SF, et al. Annual report to the Nation on the Status of Cancer, 1975–2012, featuring the increasing incidence of liver cancer. Cancer. 2016;122(9):1312–1337. - PMC - PubMed
    1. Bruix J, Sherman M, Llovet JM, et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol. 2001;35(3):421–430. - PubMed
    1. Bruix J, Sherman M, American Association for the Study of Liver Diseases Management of hepatocellular carcinoma: an update. Hepatology. 2011;53(3):1020–1022. - PMC - PubMed
    1. El-Serag HB, Marrero JA, Rudolph L, Reddy KR. Diagnosis and treatment of hepatocellular carcinoma. Gastroenterology. 2008;134(6):1752–1763. - PubMed

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