LI Meixia 1 , QIN Li 1 , QIU Zhancheng 2 , CHEN Tinghao 3 , XIE Fei 4 , YU Yu 5 , LENG Shusheng 6 , QI Weili 2 , LUO Siyuan 2 , WU Youwei 2 , XU Yueqing 2 , LI Chuan 2,3
  • 1. Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
  • 2. Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
  • 3. Department of Hepatobiliary and Pancreatic Surgery, West China Ziyang Hospital/Ziyang Central Hospital, Ziyang, Sichuan 641399, P. R. China;
  • 4. Department of Hepatobiliary and Pancreatic Surgery, The First People’s Hospital of Neijiang, Neijiang, Sichuan 641000, P. R. China;
  • 5. Department of Hepatobiliary and Pancreatic Surgery, West China Yibin Hospital/The Second People’s Hospital of Yibin, Yibin, Sichuan 644002, P. R. China;
  • 6. Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Chengdu University, Chengdu 610081, P. R. China;
LI Chuan, Email: lichuan@scu.edu.cn
hepatocellular carcinoma; alpha fetoprotein-tumor burden score; hepatectomy; prognosis
10.7507/1007-9424.202408123
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Objective  To study the effect of alpha fetoprotein-tumor burden score (ATS) on the long-term prognosis of hepatocellular carcinoma (HCC) after resection. Methods The data of 2 907 patients with HCC who underwent first hepatectomy from West China Hospital of Sichuan University, West China Ziyang Hospital/Ziyang Central Hospital, The First People’s Hospital of Neijiang, West China Yibin Hospital/The Second People’s Hospital of Yibin between 2015 and 2022, were retrospectively analyzed. The X-tile software was used to calculate the optimal truncation of the ATS score. Cox proportional hazard regression model was used to explore risk factors affecting postoperative recurrence-free survival (RFS) and overall survival (OS) in HCC patients, respectively. Results All patients were followed-up with a median of 37 months, 1 364 cases (46.9%, the recurrence time was 1–89 months after surgery) of them experienced recurrence and 841 cases (29.1%) died (the death time was 1–88 months after surgery). The 1-, 2- and 3-year OS rates were 89.3%, 81.4% and 75.9%, respectively. The 1-, 2- and 3-year RFS rates were 76.0%, 64.3% and 57.2%, respectively. The 5-year RFS rate of HCC patients with low-, medium-, and high-ATS scores were 56.4%, 45.0% and 27.2%, respectively, and patients with low ATS score had better RFS (χ2=264.747, P<0.001). The 5-year OS rate of HCC patients with low-, medium-, and high- ATS scores were 78.0%, 59.8% and 38.8%, respectively, and patients with low-ATS score had better OS (χ2=372.685, P<0.001). Multivariate Cox proportional hazard regression model suggested that, in condition of adjusting gender, age, liver function, microvascular invasion, tumor differentiation, and BCLC stage, medium-ATS score [RR=1.375, 95%CI (1.209, 1.564), P=0.005] and high-ATS score [RR=2.048, 95%CI (1.764, 2.377), P<0.001] were risk factors for postoperative RFS; the medium-ATS score [RR=1.779, 95%CI (1.499, 2.112), P<0.001] and high ATS score [RR=2.676, 95%CI (2.211, 3.239), P<0.001] were also risk factors affecting postoperative OS. Conclusion ATS score can predict the prognosis of HCC patients after resection, patients with high ATS scores had a higher incidence of postoperative recurrence and mortality.