Incorporation of alpha-fetoprotein(AFP) into subclassification of BCLC C stage hepatocellular carcinoma according to a 5-year survival analysis based on the SEER database

// Nan Zhang 1, 2, 3, * , Jiajia Gu 2, * , Li Yin 1, 2, 3 , Jing Wu 2 , Ming-yu Du 1, 2, 3 , Kai Ding 2, 3, 4 , Teng Huang 1, 2, 3 , Xia He 1, 2, 3, 4 1 The Fourth Clinical School of Nanjing Medical University, Nanjing, China 2 Department of Radiation Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, Nanjing, China 3 Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Nanjing, China 4 Xuzhou Medical University, Xuzhou, China * These authors contributed equally to this work Correspondence to: Xia He, email: hexiabm@163.com Keywords: AFP, hepatocellular carcinoma, BCLC, SEER Received: March 18, 2016 Accepted: November 01, 2016 Published: November 09, 2016 ABSTRACT Purpose: To evaluate the effect of serum alpha-fetoprotein(AFP) on prognosis of patients with hepatocellular carcinoma (HCC) and put forward a proposal to modify BCLC staging system and the recommended treatment of patients with stage C. Results: AFP positive was an independent poor prognostic factor of HCC. Race, pathological grade, T stage, M stage were also regarded to be significant predicted factors for poorer prognosis. When combining AFP status with AJCC stage, patients with A1 disease had a worse prognosis compared with those with A0 disease within each stage. Patients with A1 disease of each T/N stage had a worse prognosis than patients with A0 disease of the respective stage, and the prognosis of patients with A1 disease with lower T stages was worse or similar to that of patients with A0 disease of higher T stages. Materials and Methods: We performed a retrospective study of all patients histologically diagnosed HCC from January 1, 2004, through December 31, 2008, from the SEER database. Conclusions: AFP can be used as a subclassification index to modify the AJCC staging system of HCC. Since BCLC stage is the most widely used staging system, we recommend routine pre-treatment AFP testing as standard of care in HCC and incorporate AFP status into the BCLC staging system to modify the recommended treatment of patients with stage C.