Clinical Characteristics And Prognostic Analysis Of Hepatocellular Carcinoma With The Negative Alpha-fetoprotein

Objective To study the clinical characteristics of hepatocellular carcinoma (HCC) with the negative alpha-fetoprotein (AFP), and evaluate its prognostic factors.Methods 30 patients with AFP-negative HCC and 101 cases with AFP-positive HCC treated by hepatectomy in our hospital from January 2005 to January 2007 were compared in general datas (sex, age, alcohol abuse, clinical manifestations), basic diseases (HBsAg, anti-HCV, hapatic cirrhosis, Child-Pugh grading), intraoperative situation (tumor size, envelope, satellite lesions, tumor embolus, operative technique) and histopathological grading. Follow-ups were achieved on 26 patients with AFP-negative HCC and 93 cases with AFP-positive HCC respectively, their cumulative survival rate of 1,3, 5-year were described and compared, and analysis on the risk factors for postoperative survival of AFP-negative HCC was done.Results The presences of emaciation/weakness, abdominal pain and abdominal mass in AFP-negative HCC patients were less than those in AFP-positive HCC (53.3% vs 81.2%,56.7% vs 76.2%,13.3% vs 44.6%, P<0.05,0.05 and 0.05, respectively). AFP-negative HCC patients were less co-infected with hepatitis B virus than AFP-positive HCC (66.6% vs 90.1%, P<0.05). Child-Pugh A in AFP-negative HCC patients was more than that in AFP-positive HCC (96.7% vs 82.2%, P<0.05).Furthermore, AFP-negative HCC patients have more small size tumors (56.7% vs 31.7%, P<0.05), while less satellite lesions and tumor embolus (10.0% vs 28.7%,3.3% vs 18.8%, P<0.05 and 0.05 respectively). Patients with curative resection in AFP-negative HCC were more than in AFP-positive HCC (86.7% vs 68.3%, P< 0.05). There were no significant difference between the two groups in sex, age, alcohol dependence, jaundice, ascites, anti-HCV, hapatic cirrhosis, tumor envelope and histopathological grading.The cumulative survival rate of 1,3,5-year in AFP-negative HCC patients were higher than that in AFP-positive HCC (89.8% vs 71.6%,64.7% vs 41.8%,56.6% vs 29.7%, P<0.05,0.05 and 0.05, respectively). Univariate analysis indicated that hapatic cirrhosis, tumor embolus, operative technique, and histopathological grading were related to postoperative survival of AFP-negative HCC (P<0.05,0.05,0.05, and 0.05, respectively). Multivariable analysis showed hapatic cirrhosis, operative technique and histopathological grading were significant independent prognostic factors(P<0.05,0.05 and 0.05, respectively).Conclusion1. There was a lack of differentiable and special clinical characteristics in AFP-negative HCC patients, its diagnosis mostly depended on liver imaging and histopathologic examination. 2. There was a better prognosis in AFP-negative HCC patients than in AFP-positive HCC.3. Hapatic cirrhosis, operative technique and histopathological grading were significant independent prognostic factors of AFP-negative HCC patients after resection.