The cut-off value of AFP was 18.98 µg/L by receiver operating characteristic (ROC) curve statistics and the sensitivity and specificity rates were 54.6% and 82.0% respectively. The overall survival (OS) rate of AFP negative group (AFP < 20 µg/L) for 1, 3 and 5-year was 94.4%, 77.3% and 58.9% while the OS rate of AFP positive group (AFP ≥ 20 µg/L) for 1, 3 and 5-year 90.6%, 64.5% and 49.6%. According to univariate analysis, better prognosis for OS was associated with asymptomatic presentation, no
ascites, small
tumor, single lesion, serological AFP negativity, serological
alkaline phosphatase (ALP) negativity, high-grade histological differentiation, no
carcinoma cell
embolus, no/mild
cirrhosis, Child-Pugh class A, no transfusion, no regional
lymph node metastasis, no major vascular invasion, no direct invasion of adjacent organs or with perforation of visceral peritoneum. In multivariate analysis, asymptomatic presentation, young age, single lesion,
Alpha-Fetoprotein (AFP) negative expression, serological
alkaline phosphatase (ALP) negative expression, Child-Pugh class A, no
carcinoma cell
embolus, serological no regional
lymph node metastasis, no major vascular invasion, no direct invasion of adjacent organs, no perforation of visceral peritoneum and non-transfusion were independent factors for longer OS. Then all patients were classified into different groups by various OS time of 1, 2, 3, 5-year respectively. The statistical results showed that patients with a low expression of serum AFP had better prognosis.
CONCLUSION: Lower serum level of AFP indicates better prognosis while higher AFP level is directly correlated with more aggressive biological
tumor activities, poor background of liver and poor prognosis.