Effect of delta α-fetoprotein on the detection of liver cancer recurrence

Abstract

Background: We explored the ability of delta α-fetoprotein (ΔAFP) to detect recurrence in patients with liver cancer treated with hepatectomy.

Methods: A total of 1,846 patients diagnosed with local liver cancer who underwent hepatectomy at Sun Yat-sen University Cancer Center were enrolled in the present study. Receiver operating characteristic curve analysis was used to determine the cutoff value of ΔAFP at the last follow-up or recurrence.

Results: Recurrence occurred in 51.5% (950/1,846) of liver cancer patients. The cutoff value of ΔAFP was 1.295 ng/mL in our model. Sensitivity in our model was higher than the normal range for AFP level for detecting recurrence (59.8% vs. 43.8%), but specificity was similar (98.4% vs. 99.8%). ΔAFP in preoperative AFP-positive patients (77.16% vs. 63.28%) and AFP-negative patients (31.20% vs. 11.70%) was more sensitive than normal AFP. ΔAFP was superior to AFP in the early (78.13% vs. 63.75%) or late recurrence (56.08% vs. 39.75%) of liver cancer. Moreover, in 18.3% of patients with recurrence (174/950), ΔAFP detected recurrence earlier than computed tomography/magnetic resonance imaging by 158.33 days. ΔAFP during follow-up indicated a worse prognosis after hepatectomy.

Conclusions: The cutoff value of ΔAFP is more sensitive for monitoring recurrence than a normal AFP level in liver cancer patients.

Keywords: Liver cancer; delta α-fetoprotein (ΔAFP); hepatectomy; recurrence.

Figure 1

Delta α-fetoprotein (ΔAFP) cutoff level was compared to normal AFP level to detect recurrence (A). ΔAFP cutoff value was obtained from the receiver operating characteristic curve. ΔAFP was significantly higher in patients with than without recurrence at last follow-up (B). ΔAFP level was used to detect tumor recurrence in liver cancer (C). ΔAFP level in hepatocellular carcinoma (HCC) (E), intrahepatic cholangiocarcinoma (ICC) (G), and mixed-type HCC (I) was more sensitive than AFP level in liver cancer (D); HCC (F), ICC (H), and mixed-type HCC (J). ***, P<0.001. AFP, α-fetoprotein; HCC, hepatocellular carcinoma; ICC, intrahepatic cholangiocarcinoma.

Figure 2

Subtype analyses of delta α-fetoprotein (ΔAFP) cutoff value in the detection of liver cancer recurrence. ΔAFP showed more sensitivity in detecting tumor recurrence in preoperative AFP-positive (A) and AFP-negative (B) patients. ΔAFP best cutoff value in patients with no recurrence showed high specificity, and each histological subtype showed no statistical difference (C). A total of 174 patients had ΔAFP level exceed the cutoff value before recurrence, and the average time was earlier than that measured with computed tomography/magnetic resonance imaging (D). Δ, P>0.05. AFP, α-fetoprotein; HCC, hepatocellular carcinoma; ICC, intrahepatic cholangiocarcinoma.

Figure 3

Delta α-fetoprotein (ΔAFP) level predicts prognosis in hepatocellular carcinoma (HCC) patients. Kaplan-Meier analyses showed differences in recurrence probabilities among all cases. (A,C,D,E) Liver cancer (P<0.001) (A), HCC (P<0.001) (C), intrahepatic cholangiocarcinoma (ICC) (P=0.007) (D), and mixed-type HCC (P=0.007) (E) patients that exceeded the cutoff value more than once and those that never exceeded the value. Overall survival probabilities between liver cancer (P<0.001) (B) and HCC (P<0.001) (F) showed significant difference between the exceeded and never-exceeded groups, but ICC (P=0.365) (G) and mixed-type HCC (P=0.649) (H) showed no difference between the two groups. AFP, α-fetoprotein.