| Objective: To investigate the correlation between serum alpha-fetoprotein inconsistencies and prognosis in patients with hepatocellular carcinoma(HCC)during preoperative and postoperative recurrence.Methods: Retrospective collection of patients who underwent radical hepatocellular carcinoma resection in the affiliated tumor hospital of guangxi medical university from November 2013 to December 2016 and were diagnosed as hepatocellular carcinoma by histopathology,with initial serum AFP≥400ng/m L or AFP≤20ng/m,and recurrence occurred in postoperative follow-up.Preoperative serum AFP≥400ng/m L was defined as positive group,and preoperative AFP≤20ng/m L was defined as negative group.In the positive group,AFP < 400ng/m L in postoperative recurrence was defined as group I,where AFP≤20ng/m L was group IA(AFP levels were significantly inconsistent),AFP < 400ng/m L was group IB(inconsistent),and AFP≥400ng/m L was group II(consistent).In the negative group,patients with AFP≤20ng/m L at postoperative recurrence were in the III group(negative consistency),while AFP > 20ng/m L was in the IV group,in which 20ng/m L < AFP < 400 ng/m L was in the IVA group(negative inconsistency),and AFP≥400 ng/m L was in the IVB group(negative significantly inconsistent).Kaplan-meier method and log-rank were used for survival analysis,and COX proportional hazard model was used for multivariate analysis.Results:A total of 171 patients with HCC met the inclusion criteria,including 75 patients in the positive group and 96 patients in the negative group.In the positive group,there were 62 cases in group I(29 cases in group IA,33 cases in group IB)and 13 cases in group II.In the negative group,there were57 cases in group III and 39 cases in group IV(25 cases in group IVA,14 cases in group IVB).There were significant differences in AFP levels between patients in group IA(38.6%,29/75)and group IVB(14.6%,14/96).In the positive group,group II had the shortest survival time after recurrence(IA/II:P=0.002,IB/II:P=0.041,IA/IB:P=0.277),and the survival of group IA and IB after recurrence was significantly better than group II.In the negative group,group IVB had the shortest survival period after recurrence(IVA/III:P=0.077,IVB/III:P=0.001,IVA/IVB:P=0.122).The group IVB had significantly lower survival period after recurrence than group III.COX regression analysis of survival after HCC recurrence showed that in the positive group,microvascular invasion at the primary stage(HR=0.292,95%CI:0.105-0.740,P=0.009),early recurrence(HR=2.283,95%CI:1.105-4.720,P=0.026),tumor size at the recurrence stage(HR=0.346,95%CI:0.151-0.792,P=0.012),and tumor number(HR=0.346,95%CI:0.151-0.792,P=0.012)were independent risk factors for survival after liver cancer recurrence.However,in the univariate analysis,AFP levels were not consistent between preoperative and postoperative treatment,suggesting a risk factor for survival after recurrence(IA/II: HR=0.413,95%CI:0.176-0.972,P=0.043;IB/II:HR=0.270,95%CI:0.111-0.657,P=0.004),but not independent risk factors in multivariate analysis.In the negative group,multivariate analysis showed that AFP levels were inconsistent between preoperative and postoperative recurrence(IVA/III:HR=1.504,95%CI:0.742-3.049,P=0.257;IVB/III:HR=3.087,95%CI:1.391-6.854,P=0.006)and tumor number(HR=0.409,95%CI:0.175-0.958,P=0.04)were independent risk factors for survival after HCC recurrence.Conclusion: Among patients with negative serum AFP levels before surgery,those with strong positive AFP levels during postoperative recurrence(≥400ng/ml)had a short survival period after recurrence,which was an independent risk factor affecting the survival of patients after recurrence.However,in patients with strong positive preoperative AFP level(≥400ng/ml),decreased AFP level or negative AFP level(< 400ng/ml)during postoperative recurrence suggested a longer post-recurrence survival period,but it was not an independent risk factor affecting the survival of patients after recurrence,which needs to be further confirmed by expanding the sample size. |
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