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Markers predicted aggressiveness in early-stage hepatocellular carcinoma

Serum levels of alpha-fetoprotein and prothrombin were valid determinants of whether patients with early-stage hepatocellular carcinoma required surgical resection for micrometastases, according to study data.

In a retrospective cohort study, researchers at Seoul National University Hospital in South Korea analyzed data from 329 patients with early-stage hepatocellular carcinoma (eHCC). Single tumors were defined as being less than 3 cm. Patients underwent either surgical resection (SR; n=128) between January 2006 and December 2011 or radiofrequency ablation (RFA; n=201) between July 2007 and December 2011. SR patients were primarily men (73.4%; mean age, 55.6 years), and the RFA group was 70.1% male (mean age, 60.8 years).

Among data collected were BMI, age, sex, presence of hepatitis B and C virus, and patients’ serum levels of the tumor markers alpha-fetoprotein (AFP) and prothrombin induced by vitamin K absence-II (PIVKA-II). The patients also were assessed for risk factors for micrometastasis, which gauged tumor aggressiveness and created the potential for recurrent tumors.

Patients were followed up at 1, 3, and 6 months. At each visit patients received some type of imaging and underwent blood tests.

The product of AFP and PIVKA-II (A*P≥1,600) was the only significant risk factor for tumor aggressiveness in the SR group (HR=4.764; 95% CI, 1.867-12.161). The same markers also predicted tumor recurrence in patients in the RFA cohort (HR=2.296; 95% CI, 1.237-4.262). Patients who had RFA plus A*P≥1,600 were found to have “significant” early recurrence of tumors (P=.008) and “poor” late survival outcomes (P=.001) compared with SR patients.

“The product of AFP and PIVKA-II levels is a useful predictor of tumor aggressiveness in eHCC, and can also predict early recurrence of tumor after RFA,” the researchers concluded. “The type of treatment and the combined levels of AFP and PIVKA-II carry significant prognostic value in relation to recurrence-free survival and overall survival rates.”

Disclosure: The researchers report no relevant financial disclosures.