根据巴塞罗那临床肝癌（BCLC）算法，肿瘤负荷和肝功能，而不是肿瘤生物学，是确定肿瘤分期和治疗方式以及评估治疗预后的关键因素。血清甲胎蛋白（AFP）水平是肝细胞癌（HCC）生物学的重要特征，我们的目的是评估其对接受早期HCC肝切除术的患者的预后价值。接受早期根治性肝切除术的患者HCC 是从多机构数据库中鉴定出来的。根据术前AFP水平将患者分为三组：低（<400ng/mL）、高（400-999ng/mL）和极高（≥1000ng/mL）AFP组。比较三组的总生存率（OS）和复发率。1284 例患者中，720 例（56.1%）、262 例（20.4%）和 302 例（23.5%）患者术前 AFP 水平低、高和极高， 分别。低 AFP 组患者的累积 5 年 OS 和复发率分别为 71.3 和 38.9%，高 AFP 组患者为 66.3 和 48.5%，极高 AFP 组患者为 45.7 和 67.2%（均 p < 0.001）。多变量 Cox 回归分析确定高 AFP 水平和极高 AFP 水平都是 OS 的独立危险因素（风险比 [HR] 1.275 和 1.978，95% 置信区间 [CI] 分别为 1.004-1.620 和 1.588-2.464；p = 0.047和 p < 0.001）和复发（HR 1.290 和 2.050，95% CI 分别为 1.047-1.588 和 1.692-2.484；分别为 p = 0.017 和 p < 0.001）。这项研究证明了术前 AFP 水平的重要预后价值接受早期 HCC 切除术的患者。将 AFP 纳入 BCLC 算法的预后评估有助于指导个体化风险分层并确定新辅助/辅助治疗的必要性。© 2023。外科肿瘤学会。

According to the Barcelona Clinic Liver Cancer (BCLC) algorithm, tumor burden and liver function, but not tumor biology, are the key factors in determining tumor staging and treatment modality, and evaluating treatment prognosis. The serum α-fetoprotein (AFP) level is an important characteristic of hepatocellular carcinoma (HCC) biology, and we aimed to evaluate its prognostic value for patients undergoing liver resection of early-stage HCC.Patients who underwent curative liver resection for early-stage HCC were identified from a multi-institutional database. Patients were divided into three groups according to preoperative AFP levels: low (< 400 ng/mL), high (400-999 ng/mL), and extremely-high (≥ 1000 ng/mL) AFP groups. Overall survival (OS) and recurrence rates were compared among these three groups.Among 1284 patients, 720 (56.1%), 262 (20.4%), and 302 (23.5%) patients had preoperative low, high, and extremely-high AFP levels, respectively. The cumulative 5-year OS and recurrence rates were 71.3 and 38.9% among patients in the low AFP group, 66.3 and 48.5% in the high AFP group, and 45.7 and 67.2% in the extremely-high AFP group, respectively (both p < 0.001). Multivariate Cox regression analysis identified both high and extremely-high AFP levels to be independent risk factors of OS (hazard ratio [HR] 1.275 and 1.978, 95% confidence interval [CI] 1.004-1.620 and 1.588-2.464, respectively; p = 0.047 and p < 0.001, respectively) and recurrence (HR 1.290 and 2.050, 95% CI 1.047-1.588 and 1.692-2.484, respectively; p = 0.017 and p < 0.001, respectively).This study demonstrated the important prognostic value of preoperative AFP levels among patients undergoing resection for early-stage HCC. Incorporating AFP to prognostic estimation of the BCLC algorithm can help guide individualized risk stratification and identify neoadjuvant/adjuvant treatment necessity.© 2023. Society of Surgical Oncology.