Prediction of aggressiveness in early-stage hepatocellular carcinoma for selection of surgical resection.

Abstract

BACKGROUND & AIMS:

In early-stage hepatocellular carcinoma (eHCC), radiofrequency ablation (RFA) has comparable outcomes to surgical resection (SR); however, micrometastases may be present, resulting in tumor recurrence after local ablation. Therefore, we investigated predictors of aggressiveness in eHCC to select patients at high risk of recurrence after RFA who would benefit from SR.

METHODS:

First, we analyzed 128 patients with newly diagnosed eHCC (single tumor with a diameter <3 cm) who underwent SR between January 2006 and December 2011. Risk factors for micrometastasis (representative of tumor aggressiveness) such as microvascular invasion or poor histologic grade were investigated. We then analyzed 201 eHCC patients who underwent RFA between July 2007 and December 2011. Identified risk factors were validated to determine their influence on tumor recurrence.

RESULTS:

The only significant risk factor for tumor aggressiveness in the SR group was the product of serum levels of α-fetoprotein (AFP) and prothrombin induced by vitamin K absence-II (PIVKA-II) (A∗P ≥1600; hazard ratio [HR] 4.764; 95% confidence interval [CI], 1.867-12.161; p=0.001). This product also showed statistical significance for predicting recurrence in the RFA group (HR 2.296; 95% CI, 1.237-4.262; p=0.008). Patients with RFA and A∗P ≥1600 had significant early tumor recurrence (p=0.008) and poor late survival outcomes (p=0.001) compared with other patients.

CONCLUSIONS:

The product of AFP and PIVKA-II levels is a useful predictor of aggressiveness in eHCC, which predicts tumor recurrence after RFA. Therefore, it should be considered when selecting SR as first-line treatment.

• Authors: Suk-Won Suh, Kwang-Woong Lee, Jeong-Moo Lee, Tae You, YoungRok Choi, Hyeyoung Kim, Hae Won Lee, Jeong-Min Lee, Nam-Joon Yi, Kyung-Suk Suh
• Journal: Journal of hepatology (J Hepatol) Vol. 60 Issue 6 Pg. 1219-24 (Jun 2014) ISSN: 1600-0641 [Electronic] Netherlands
• PMID: 24548529 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Topics

• Aged
• Carcinoma, Hepatocellular (mortality, pathology, surgery)
• Catheter Ablation
• Early Diagnosis
• Female
• Humans
• Liver Neoplasms (mortality, pathology, surgery)
• Male
• Middle Aged
• Multivariate Analysis
• Neoplasm Invasiveness
• Neoplasm Recurrence, Local (epidemiology)
• Neoplasm Staging
• Patient Selection
• Predictive Value of Tests
• Proportional Hazards Models
• Retrospective Studies
• Risk Factors
• Survival Analysis