Prognostic impact of surgical margins for hepatocellular carcinoma according to preoperative alpha-fetoprotein level
Abstract
Background: HCC are known to have satellite nodules and microvascular invasions requiring sufficient margins. An alpha-fetoprotein (AFP) level >100 ng/mL is associated with worse pathological features in HCC. In practice, large resection margins, particularly >1 cm, are infrequently retrieved on the specimens.
Methods: 397 patients from 5 centres were included from 2012 to 2017. The primary endpoint was time-to-recurrence in relation to AFP level (> or <100 ng/ml) as well as surgical margins (> or <1 cm). The secondary endpoint was overall survival (OS).
Results: The median follow-up was 25 months. In Low AFP group, median time to recurrence (TTR) for patients with margins <1 cm was 36 months and for patients with margins ≥1 cm was 34 months (p = 0.756), and overall survival (OS) was not significantly different according to margins (p = 0.079). In High-AFP group, patients with margins <1 cm had a higher recurrence rate than patients with margins ≥1 cm (p = 0.016): median TTR for patients with margins <1 cm was 8 months whereas it was not reached for patients with margins ≥1 cm. Patients with margins <1 cm had a significantly worse OS compared to the patients with margins ≥1 cm (p = 0.043).
Conclusion: Preoperative AFP level may help determine margins to effectively treat high AFP tumours. For low-AFP tumours, margins didn't have an impact on TTR or OS.
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Date
2021-11-01
Type
Article
Subject
Gastroenterology, Oncology. Pathology.
Collections
Citation
Marques F, Ghallab M, Vibert E, Boleslawski E, Soubrane O, Adam R, Farges O, Mabrut JY, Régimbeau JM, Cherqui D, Allard MA, Sa Cunha A, Samuel D, Pruvot FR, Golse N. Prognostic impact of surgical margins for hepatocellular carcinoma according to preoperative alpha-fetoprotein level. HPB (Oxford). 2022 Jun;24(6):848-856. doi: 10.1016/j.hpb.2021.10.012. Epub 2021 Nov 1.
Journal / Source Title
HPB
DOI
10.1016/j.hpb.2021.10.012
PMID
34785122
Publisher
Elsevier
Publisher’s URL
https://www.hpbonline.org/