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Using Serum α-Fetoprotein for Prognostic Prediction in Patients with Hepatocellular Carcinoma: What is the Most Optimal Cutoff?

BACKGROUND AND AIMS: The prognostic ability of α-fetoprotein (AFP) for patients with hepatocellular carcinoma (HCC) was examined by using different cutoff values. The optimal AFP cutoff level is still unclear. METHODS: A total of 2579 HCC patients were consecutively enrolled in Taiwan, where hepatit...

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Autores principales: Hsu, Chia-Yang, Liu, Po-Hong, Lee, Yun-Hsuan, Hsia, Cheng-Yuan, Huang, Yi-Hsiang, Lin, Han-Chieh, Chiou, Yi-You, Lee, Fa-Yauh, Huo, Teh-Ia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4349891/
https://www.ncbi.nlm.nih.gov/pubmed/25738614
http://dx.doi.org/10.1371/journal.pone.0118825
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author Hsu, Chia-Yang
Liu, Po-Hong
Lee, Yun-Hsuan
Hsia, Cheng-Yuan
Huang, Yi-Hsiang
Lin, Han-Chieh
Chiou, Yi-You
Lee, Fa-Yauh
Huo, Teh-Ia
author_facet Hsu, Chia-Yang
Liu, Po-Hong
Lee, Yun-Hsuan
Hsia, Cheng-Yuan
Huang, Yi-Hsiang
Lin, Han-Chieh
Chiou, Yi-You
Lee, Fa-Yauh
Huo, Teh-Ia
author_sort Hsu, Chia-Yang
collection PubMed
description BACKGROUND AND AIMS: The prognostic ability of α-fetoprotein (AFP) for patients with hepatocellular carcinoma (HCC) was examined by using different cutoff values. The optimal AFP cutoff level is still unclear. METHODS: A total of 2579 HCC patients were consecutively enrolled in Taiwan, where hepatitis B is the major etiology of chronic liver disease. Four frequently used AFP cutoff levels, 20, 200, 400, 1000 ng/mL, were investigated. One-to-one matched pairs between patients having AFP higher and lower than the cutoffs were selected by using the propensity model. The adjusted hazard ratios of survival difference were calculated with Cox proportional hazards model. RESULTS: Patients with a higher AFP level were associated with more severe cirrhosis, more frequent vascular invasion, higher tumor burden and poorer performance status (all p<0.0001). In the propensity model, 4 groups of paired patients were selected, and there was no difference found in the comparison of baseline characteristics (all p>0.05). Patients with AFP <20 ng/mL had significantly better long-term survival than patients with AFP ≧20 ng/mL (p<0.0001), and patients with AFP <400 ng/mL had significantly better overall outcome than patients with AFP ≧400 ng/mL (p = 0.0186). There was no difference of long-term survival between patients divided by AFP levels of 200 and 1000 ng/mL. The adjusted hazard ratios of AFP ≧20 ng/mL and AFP ≧400 ng/mL were 1.545 and 1.471 (95% confidence interval: 1.3–1.838 and 1.178–1.837), respectively. CONCLUSIONS: This study shows the independently predictive ability of baseline serum AFP level in HCC patients. AFP levels of 20 and 400 ng/mL are considered feasible cutoffs to predict long-term outcome in unselected HCC patients.
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spelling pubmed-43498912015-03-17 Using Serum α-Fetoprotein for Prognostic Prediction in Patients with Hepatocellular Carcinoma: What is the Most Optimal Cutoff? Hsu, Chia-Yang Liu, Po-Hong Lee, Yun-Hsuan Hsia, Cheng-Yuan Huang, Yi-Hsiang Lin, Han-Chieh Chiou, Yi-You Lee, Fa-Yauh Huo, Teh-Ia PLoS One Research Article BACKGROUND AND AIMS: The prognostic ability of α-fetoprotein (AFP) for patients with hepatocellular carcinoma (HCC) was examined by using different cutoff values. The optimal AFP cutoff level is still unclear. METHODS: A total of 2579 HCC patients were consecutively enrolled in Taiwan, where hepatitis B is the major etiology of chronic liver disease. Four frequently used AFP cutoff levels, 20, 200, 400, 1000 ng/mL, were investigated. One-to-one matched pairs between patients having AFP higher and lower than the cutoffs were selected by using the propensity model. The adjusted hazard ratios of survival difference were calculated with Cox proportional hazards model. RESULTS: Patients with a higher AFP level were associated with more severe cirrhosis, more frequent vascular invasion, higher tumor burden and poorer performance status (all p<0.0001). In the propensity model, 4 groups of paired patients were selected, and there was no difference found in the comparison of baseline characteristics (all p>0.05). Patients with AFP <20 ng/mL had significantly better long-term survival than patients with AFP ≧20 ng/mL (p<0.0001), and patients with AFP <400 ng/mL had significantly better overall outcome than patients with AFP ≧400 ng/mL (p = 0.0186). There was no difference of long-term survival between patients divided by AFP levels of 200 and 1000 ng/mL. The adjusted hazard ratios of AFP ≧20 ng/mL and AFP ≧400 ng/mL were 1.545 and 1.471 (95% confidence interval: 1.3–1.838 and 1.178–1.837), respectively. CONCLUSIONS: This study shows the independently predictive ability of baseline serum AFP level in HCC patients. AFP levels of 20 and 400 ng/mL are considered feasible cutoffs to predict long-term outcome in unselected HCC patients. Public Library of Science 2015-03-04 /pmc/articles/PMC4349891/ /pubmed/25738614 http://dx.doi.org/10.1371/journal.pone.0118825 Text en © 2015 Hsu et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Hsu, Chia-Yang
Liu, Po-Hong
Lee, Yun-Hsuan
Hsia, Cheng-Yuan
Huang, Yi-Hsiang
Lin, Han-Chieh
Chiou, Yi-You
Lee, Fa-Yauh
Huo, Teh-Ia
Using Serum α-Fetoprotein for Prognostic Prediction in Patients with Hepatocellular Carcinoma: What is the Most Optimal Cutoff?
title Using Serum α-Fetoprotein for Prognostic Prediction in Patients with Hepatocellular Carcinoma: What is the Most Optimal Cutoff?
title_full Using Serum α-Fetoprotein for Prognostic Prediction in Patients with Hepatocellular Carcinoma: What is the Most Optimal Cutoff?
title_fullStr Using Serum α-Fetoprotein for Prognostic Prediction in Patients with Hepatocellular Carcinoma: What is the Most Optimal Cutoff?
title_full_unstemmed Using Serum α-Fetoprotein for Prognostic Prediction in Patients with Hepatocellular Carcinoma: What is the Most Optimal Cutoff?
title_short Using Serum α-Fetoprotein for Prognostic Prediction in Patients with Hepatocellular Carcinoma: What is the Most Optimal Cutoff?
title_sort using serum α-fetoprotein for prognostic prediction in patients with hepatocellular carcinoma: what is the most optimal cutoff?
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4349891/
https://www.ncbi.nlm.nih.gov/pubmed/25738614
http://dx.doi.org/10.1371/journal.pone.0118825
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