| Objective To investigate the correlation between preoperative serum alpha fetal protein (AFP) level, measured actual tumor volume (ATV) and AFP/ATV and the prognosis of patients with HCC stage BCLC-A after radical resection.Methods A review of the clinical data of 302 patients with HCC stage BCLC-A after radical resection treated in Cancer Hospital of Guangxi Medical University from January 2007 to December 2014. The clinical data of 302 patients were analyzed by univariate and multivariate analyses based on Cox risk regression model. We analyzed the date of preoperative AFP levels in patients with postoperative 1,3,5 year on disease-free survival by The Kaplan Meier method and the life table method. The receiver operating characteristic (ROC) curve was used to calculated ATV optimal diagnostic critical value. Using the life table method to analyze the relationship between ATV and the 1,3 and 5 year survival rate of patients after operation. Pearson correlation coefficient was used to analyze the relationship between ATV and preoperative AFP level, and the relationship between preoperative AFP level and histological differentiation type was analyzed. ROC curve was used to calculate the optimal diagnostic value of AFP/ATV. The life table method was used to analyze the relationship between AFP/ATV and the 1,3 and 5 year disease-free survival of patients after operation.Result Univariate analysis showed that preoperative AFP, preoperative ALT, Integrity of tumor capsule, age, sex, and ATV were the risk factors for recurrence of HCC stage BCLC-A after radical resection. Multivariate analysis revealed that preoperative AFP, ALT before operation, tumor capsule is complete.Preoperative AFP positive group 1,3 and 5 year disease-free survival rate was significantly lower than preoperative AFP negative group (x2=5.545, P =0.019); Preoperative AFP≥400ng/ml group 1,3, and 5 year disease-free survival rate was lower than that of preoperative AFP> 20-200ng/ml group and preoperative AFP> 200-400ng/ml group (x2=6.338, P= 0.012; x2=4.561, P= 0.033); Preoperative AFP> 20-200ng/ml group and preoperative AFP> 200-400ng/ml group of 1,3,5 years disease free-survival rate was not statistically significant (x2= 1.627, P=0.202). Preoperative AFP positive patients serum AFP level and The pathological differentiation type were weakly correlated (P=0.006, r=0.224).ROC curves indicated that the prediction of radical resection of BCLC-A period in patients with HCC recurrence ATV optimal diagnostic critical value was 13.78 cm3, its sensitivity was 35.4% and the specificity was 90.0%. The 1,3 and 5 year disease-free survival rate of ATV ≥13.78 cm3 group was significantly lower than that of ATV< 13.78 cm3 group (x2=15.135, P=0.000), There is no direct correlation between ATV and The pathological differentiation type (P=0.161, r=0.081). ROC curves predicted radical resection of BCLC-A period in patients with HCC recurrence and 21.72 value for AFP/ATV best diagnostic boundary value; the sensitivity is 60.8% and the specificity was 79.1%; The 1,3 and 5 year disease-free survival rate of AFP/ATV≥21.72 group was significantly lower than that of AFP/ATV<21.72 group (x2=65.374; P=0.000); preoperative AFP and ATV levels were weakly correlated (P=0.036, r=0.121).Conclusion1.Preoperative AFP, ALT before operation, tumor capsule is complete, age, gender, ATV is the high risk factors for postoperative recurrence in patients with radical resection stage BCLC-A of HCC. Preoperative AFP, ALT before operation, tumor capsule is complete, ATV is the effect of radical resection BCLC-A period of HCC patients with postoperative recurrence of independent risk factors.2.Preoperative AFP> 400 ng/ml, ATV> 13.78 cm3 and AFP/ATV> 21.72 radical resection operation of BCLC-A period prognosis of HCC patients is relatively poor.3.Preoperative AFP and AFP/ATV can be used as important indicators to assess the risk of recurrence in patients with HCC stage BCLC-A who underwent radical resection. |
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