Alpha-1-fucosidase as a prognostic indicator for hepatocellular carcinoma following hepatectomy: a large-scale, long-term study

BACKGROUND: Preoperative alpha-L-fucosidase (AFU) has been used as a diagnostic biomarker for hepatocellular carcinoma (HCC), but its role as a prognostic predictor after partial hepatectomy has not been well defined. The study aimed to investigate the prognostic significance of preoperative serum AFU for HCC patients after hepatic resection. METHODS: A retrospective training data set and a prospective validation data set were used to evaluate the prognosis of HCC after partial hepatectomy. A total of 669 patients with histopathologically confirmed HCC were enrolled. Univariate and multivariate analyses were used to identify the prognostic significance of preoperative serum AFU. RESULTS: The retrospective training data set showed a preoperative AFU>35 u l(−1) should be used. The prospective validation data set showed preoperative AFU was an independent prognostic factor of overall survival (OS) (P=0.008; hazard ratio: 2.333; 95% confidence interval: 1.249–4.369). Patients with a preoperative AFU>35 u l(−1) had a lower recurrence-free survival rate and an OS rate than those with AFU⩽35 u l(−1), and they have a higher tendency to form macrovascular invasion. Furthermore, the prognostic significance of AFU>35 u l(−1) could also be applied to patients with alpha-fetoprotein levels of ⩽400 ng ml(−1). CONCLUSIONS: Preoperative serum AFU is a prognostic predictor of HCC.