Clinical characteristics and prognosis of hepatocellular carcinoma - Analaysis based on serum alpha-fetoprotein levels

The purpose of this study was to determine whether a relation does exist be tween clinicopathologic features and the prognosis of hepatocellular carcin oma (HCC) with respect to serum alpha-fetoprotein (AFP) levels at diagnosis . We reviewed the clinical data of 309 pathologically proven HCC cases divi ded into three groups: group I with normal AFP (<20 IU/mL), group 2 with mo derately elevated AFP (20-399 IU/mL) and group 3 with markedly elevated AFP (<greater than or equal to>400 IU/mL). Of these, there were 76 (24.6%), 78 (25.2%), and 155 patients (50.2%) in groups 1, 2, and 3, respectively. We found that HCC patients with high AFP tended to have greater tumor size, bi lobar involvement, massive or diffuse types, and portal vein thrombosis. No netheless, we could not establish a correlation between increased AFP and O kuda's stages, degree of tumor differentiation, or extrahepatic metastasis. The median survival rates in groups 1 (6 months) and 2 (7 months) were sig nificantly longer than that of group 3 (3 months). On multivariate logistic regression analysis, positive hepatitis B surface antigen (HBsAg) status a nd bilobar tumor involvement represented the independent factors for predic ting high AFP values. We concluded that AFP is useful not only for diagnosi s, but also as a prognostic indicator in patients with HCC. However, it can not be considered a sensitive tumor marker, particularly during the early s tages in HBsAg-negative patients.