Liver Cancer
Copyright ©2005 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 28, 2005; 11(44): 6920-6925
Published online Nov 28, 2005. doi: 10.3748/wjg.v11.i44.6920
Role of blood AFP mRNA and tumor grade in the preoperative prognostic evaluation of patients with hepatocellular carcinoma
Umberto Cillo, Alessandro Vitale, Filippo Navaglia, Daniela Basso, Umberto Montin, Marco Bassanello, Francesco D’Amico, Francesco Antonio Ciarleglio, Alberto Brolese, Giacomo Zanus, Vito De Pascale, Mario Plebani, Davide Francesco D’Amico
Umberto Cillo, Alessandro Vitale, Umberto Montin, Marco Bassanello, Francesco D’Amico, Francesco Antonio Ciarleglio, Alberto Brolese, Giacomo Zanus, Davide Francesco D’Amico, Clinica Chirurgica I, Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Università degli Studi di Padova, Italy
Filippo Navaglia, Daniela Basso, Mario Plebani, Dipartimento di Medicina di Laboratorio, Università degli Studi di Padova, Italy
Vito De Pascale, Dipartimento Assistenziale di Chirurgia Generale ed Emergenze Chirurgiche, II Università degli Studi di Napoli, Italy
Author contributions: All authors contributed equally to the work.
Correspondence to: Alessandro Vitale, MD, Clinica Chirurgica I - Dipartimento di Scienze Chirurgiche e Gastroenterologiche - Università degli Studi di Padova - Via Giustiniani 2, Policlinico III piano, 35128 Padova, Italy. alessandro.vitale@unipd.it
Telephone: +39-49-8212210 Fax: +39-49-656145
Received: February 17, 2005
Revised: April 23, 2005
Accepted: April 26, 2005
Published online: November 28, 2005
Abstract

AIM: To explore the potential prognostic role of preoperative tumor grade and blood AFP mRNA in a cohort of patients with hepatocellular carcinoma (HCC) eligible for radical therapies according to a well-defined treatment algorithm not including nodule size and number as absolute selection criteria.

METHODS: Fifty patients with a diagnosis of HCC were prospectively enrolled in the study. Inclusion criteria were: (1) histological assessment of tumor grade by means of percutaneous biopsies; (2) determination of AFP mRNA status in the blood; (3) patient’s eligibility for radical therapies.

RESULTS: At preoperative evaluation, 54% of the study group had a well-differentiated HCC, 42% had AFP mRNA in the blood, 40% had a tumor larger than 5 cm and 56% had more than one nodule. Surgery (resection or liver transplantation) was performed in 29 patients, while 21 had percutaneous ablation procedures. After a median follow-up of 28 mo, 12-, 24-, and 36-mo survival rates were 78%, 58%, and 51%, respectively. Surgical therapy, performance status and three tumor-related variables (AFP mRNA, HCC grade and gross vascular invasion) resulted as significant survival predictors at univariate analysis. Nodule size and number did not perform as significant prognosticators. Multivariate study selected only surgical therapy and a biologically early HCC profile (AFP mRNA negative and well-differentiated tumor without gross vascular invasion) as independent survival variables.

CONCLUSION: The preoperative determination of tumor grade and blood AFP mRNA status may potentially refine the prognostic evaluation of HCC patients and improve the selection process for radical therapies.

Keywords: Hepatocellular carcinoma, Prognosis, Treatment policy, Biomarker, Tumor biology