Negative serum alpha-fetoprotein at recurrence predicts good prognosis in recurrent hepatocellular carcinoma patients receiving repeated hepatectomy:a single-center retrospective cohort study.

Background: The serum alpha-fetoprotein (AFP) serves as a crucial prognostic indicator in patients diagnosed with hepatocellular carcinoma (HCC). Examining the impact of baseline-AFP (b-AFP), recurrence -AFP (r-AFP), and changes in AFP levels on the prognosis of individuals with recurrent hepatocellular carcinoma (RHCC) who undergo repeated hepatectomy holds substantial clinical significance.

Method: A total of 400 RHCC patients who had undergone repeated hepatectomy in the Center of Hepato-Pancreato-Biliary Surgery at the First Affiliated Hospital of Sun Yat-Sen University between January 1, 2006, and December 31, 2019 were included in this study. The analysis focused on evaluating the impact of b-AFP, r-AFP, and changes in AFP levels on the prognosis of RHCC patients.

Results: The recurrence rate among HCC patients who underwent hepatectomy was approximately 40.03 %. Among the 400 HCC patients who underwent twice hepatectomy, the 5-year mortality rate was 34.25 %, with an overall mortality rate of 38.75 %. Survival analysis indicated statistically significant disparities in overall survival (OS) and recurrence-free survival (RFS) between the b-AFP (-) group and the b-AFP (+) group, with the latter exhibiting shorter OS and RFS. The 3-year mortality rates for the two groups were 31.7 % and 42.5 %, respectively. The median overall survival (mOS) for the two groups were 107.4 months and 89.5 months, respectively. A statistically significant discrepancy in recurrence-death survival (RDS) was observed between the r-AFP (-) and r-AFP (+) groups (P < 0.0001), with patients in the r-AFP (+) category experiencing a shorter RDS. The median RDS for these two groups were 88.1 months and 31.7 months, respectively. Significant differences in both overall survival (OS) and RDS were observed among the AFP (+/+), AFP (±), AFP (-/+), and AFP (-/-) groups. The order of OS and RDS from lowest to highest was as follows: AFP (+/+) group < AFP (-/+) group < AFP (-/-) group < AFP (±) group. Irrespective of the b-AFP status, patients with positive r-AFP exhibited notably shorter OS and RFS compared to their r-AFP negative counterparts. The 3-year mortality rates for the four groups were 50.9 %, 26.1 %, 39.3 %, and 29.7 %, respectively. Median OS values were 42.4 months, not reached (NA), 77.1 months, and 107.4 months, respectively. Furthermore, an analysis of the cumulative 1-year, 3-year, and 5-year OS, RDS, and RFS rates for each group was conducted.

Conclusion: The b-AFP, r-AFP and AFP fluctuations serve as valuable prognostic indicators in individuals who have undergone hepatectomy for HCC on two occasions. These indicators can offer valuable insights for guiding the diagnosis and treatment strategies for HCC recurrence in such patients.