Changes of serum alpha-fetoprotein and alpha-fetoprotein-L3 after hepatectomy for hepatocellular carcinoma: prognostic significance
Xiao-Feng Zhang, Zheng-Feng Yin, Kui Wang, Zong-Qin Zhang,
Hai-Hua Qian and Le-Hua Shi
Shanghai, China

BACKGROUND: Alpha-fetoprotein (AFP) is the most established
tumor marker of hepatocellular carcinoma (HCC), but one of its
limitations is non-specificity. Many studies have demonstrated
that alpha-fetoprotein-L3 (AFP-L3) is more specific than AFP in
the early diagnosis and prognosis of HCC. However, there is a
lack of knowledge about the post-hepatectomy profiles of serum
AFP and AFP-L3 values in HCC patients. To identify the profiles
after surgical resection of HCC, we analyzed the correlation
between the profiles and postoperative HCC recurrence or
survival, and evaluated their utility in predicting postoperative
therapeutic efficacy and prognosis.
METHODS: From August 2003 to December 2004, 318 patients
with positive serum AFP who had received surgical resections
were enrolled in this study. Preoperative and postoperative
serum AFP and AFP-L3 levels were measured simultaneously
and regularly, and their postoperative profiles during a longterm
follow-up were recorded and summarized.
RESULTS: A high ratio of AFP-L3 to total AFP was shown to
correlate with pathologic features of aggressiveness. The overall
1-, 3-, and 5-year recurrence rates of the whole series were 28%,
57%, and 84%, and the overall survival rates were 86%, 61%,
and 33%, respectively. The changes of serum AFP and AFP-L3
after hepatectomy for HCC were classified into 3 groups (group
A: AFP-L3 undetectable; group B: AFP-L3 <10%; and group
C: AFP-L3 >10%). Patients with positive postoperative AFP-L3 had significantly earlier recurrence than those with negative
results. The overall survival was significantly shorter in the
positive groups than in the groups negative for postoperative
AFP-L3.
CONCLUSION: Post-hepatectomy changes in serum AFP and
AFP-L3 levels occurred in three distinct patterns, which were
closely correlated with HCC recurrence and patient survival
with different prognostic values.
(Hepatobiliary Pancreat Dis Int 2012;11:618-623)