Clincal Features And Porgnosis Of Non-B Non-C-AFP(-) Related Hepatocellular Carcinomas

Objective: To Study the clinical features and prognostic features of the non-BnonC-alpha-feteroprotein (AFP)(-)–hepatocelluar carcinoma (HCC)(NBNC-AFP(-)-HCC), and the relationship between the prognostic features of HCCand the different status of hepatitis B virus surface antigen (HBsAg) and AFP.Methods: We enrolled227patients underwent hepatic resection for HCC betweenJanuary1998and December2007of Sun Yat-Sen University, all of them werediagnosed with HCC by pathology. All the227patients were strafified according toAFP levels and HBsAg status, including Group1. B-AFP(+)-HCC（HBsAg PositiveHCVAb Negative AFP Positive）93cases; Group2. B-AFP(-)-HCC（HBsAg PositiveHCVAb Negative AFP Negative）29cases; Group3. NBNC-AFP(+)-HCC （HBsAgNegative HCVAb Negative AFP Positive）62cases; and Group4. NBNC-AFP(-)-HCC（HBsAg Negative HCVAb NegativeAFP Negative）43cases.Conclusion: The NBNC-HCC was significantly correlated with age, BMI,diabetes, metabolic-syndrome group, ALT、AST、S/T、tumor number, Portal Invasionand pathological type (P<0.05).On univariate analysis, AST, tumor size, tumor number, Portal Invasion wereprognostic factors for disease-free survival (DFS)(P <0.05). COX Multivariateregression analysis suggested tumor size, tumor number and Portal Invasion (P <0.05)were independent predictors. On univariate analysis, tumor size,tumor number andPortal Invasion were prognostic factors for overall survival (OS)(P <0.05). COXMultivariate regression analysis suggested tumor size, tumor number (P <0.05) wereindependent predictors.In addition, NBNC-AFP(-)-HCC were prognostic factors for disease-freesurvival (DFS)(P <0.05). No prognostic factors were found for overall survival (OS)(P <0.05).In Kaplan-Meier survival analysis, compared with the groups of theB-AFP(+)-HCC, B-AFP(-)-HCC and NBNC-AFP(+)-HCC, NBNC-AFP(-)-HCCpatients have the best disease-free survival (DFS)(P <0.05). For NBNC-AFP(-)-HCC patients, the median of the disease-free survival time was90months (range:1-132months).The1-,2-,3-,5-and10-year the DFS time rateswere84.6%,72.9%,68.8%,51%and40.8%respectively. Compared with the groupsof the B-AFP(+)-HCC and NBNC-AFP(+)-HCC, NBNC-AFP(-)-HCC patients havebetter overall survival (OS)(P<0.05), survival rates were similar toB-AFP(-)-HCC.The median survival time was10years (range:1-11years). The1-,3-,5-and10-year OS were93%,76.1%,65.1%and52.1%respectively.Conclusion: HBsAg and the AFP negative for both expression can serve as auseful marker to predict the risk of tumor recurrence in the early stage.