# Does very high alpha-fetoprotein affect very early hepatocellular carcinoma receiving hepatectomy?

## TL;DR

The study found that very high alpha-fetoprotein levels do not worsen survival in early-stage liver cancer patients after surgery.

## Contribution

The study shows that high AFP levels do not affect survival in early hepatocellular carcinoma after surgery.

## Key findings

- High AFP levels (>1,000 ng/ml) did not correlate with worse disease-free or overall survival in BCLC stage 0 HCC patients.
- Clinicopathologic features like tumor size and cirrhosis were similar between low and high AFP groups.
- HCC recurrence was linked to ICG R15, HAI score, and cirrhosis, but not AFP levels.

## Abstract

Following liver resection (LR), recurrence is critical to the prognosis of hepatocellular carcinoma (HCC). A higher level of alpha-fetoprotein (AFP) is typically associated with poor prognosis and recurrence concerns. Specifically, we attempted to determine whether high AFP (> 1,000ng/ml) and other potentially relevant factors affect survivals of patients with BCLC stage 0 HCC after LR.

This retrospective study focused on 223 patients who received LR for stage 0 HCC of BCLC between 2004 and 2012. In patients with a low AFP (n = 200) and a high AFP (n = 23), we conducted chi-squares, independent t-test, Cox regression, and Kaplan–Meier survival analyses to investigate the relationship between clinicopathologic variables and outcomes.

The long-term disease-free survival (DFS) (p = 0.799) and the overall survival (OS) (p = 0.942) between the low and high AFP groups were comparable. The two groups' clinicopathologic features—tumor size, presence of a tumor capsule, cirrhosis, histology activity index (HAI), and microvascular invasion—appear to be similar. Additionally, we observed significant associations between HCC recurrence and ICG R15, HAI score, and cirrhosis, but not AFP.

In stage 0 HCC, the consideration of curative-intent therapy in these patients should begin as soon as possible, irrespective of AFP levels.

The online version contains supplementary material available at 10.1007/s00423-025-03675-y.