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Clinical outcomes of patients with a high alpha-fetoprotein level but without evident recurrence on CT or MRI in surveillance after curative-intent treatment for hepatocellular carcinoma

  • Hepatobiliary
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Abstract

Purpose

Multiphasic CT or MRI and serum alpha-fetoprotein (AFP) are widely used for posttreatment surveillance of hepatocellular carcinoma (HCC). This study aimed to investigate the clinical outcomes of patients with high posttreatment AFP but without evident recurrence on CT or MRI after curative-intent treatment of HCC.

Methods

We retrospectively analyzed 121 patients presenting with high posttreatment AFP (> 20 ng/mL) without evident recurrence on multiphasic CT or MRI during surveillance after curative-intent surgical resection or radiofrequency ablation (RFA) for HCC. The time interval from the first event of high posttreatment AFP to imaging-evident recurrence (TimeAFP-Imaging recurrence) was estimated using the Kaplan–Meier method. Cox regression analyses were performed to assess the associated factors with TimeAFP-Imaging recurrence.

Results

The median TimeAFP-Imaging recurrence was 20.0 months (95% CI 13.0–28.0 months), and the estimated 6-month and 1-year cumulative incidences of imaging-evident recurrence were 24.4% and 40.1%, respectively. In multivariate Cox analyses, late onset of AFP elevation (> 3 months after treatment) was an independent predictor of shorter TimeAFP-Imaging recurrence (HR 2.11, P = 0.015) if using variables available at the first event of AFP elevation, while non-normalization of AFP at the next follow-up was an independent predictor of shorter TimeAFP-Imaging recurrence (HR 3.65, P < 0.001) if using variables including the follow-up data.

Conclusion

In the surveillance setting after curative-intent treatment of HCC, patients presenting with high posttreatment AFP without evident recurrence on CT or MRI may frequently progress to imaging-evident recurrence. In high-risk patients, an extensive diagnostic workup or close monitoring is needed to detect HCC recurrence earlier.

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Abbreviations

AFP:

Alpha-fetoprotein

HCC:

Hepatocellular carcinoma

IDR:

Intrahepatic distant recurrence

LI-RADS:

Liver imaging reporting and data system

LTP:

Local tumor progression

RFA:

Radiofrequency ablation

TimeAFP-Imaging recurrence :

Time interval from the first event of high posttreatment AFP to imaging-evident recurrence

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The authors received no specific funding for this work.

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Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, Seoul, South Korea

    Jihyuk Lee, Ijin Joo, Dong Ho Lee, Sun Kyung Jeon & Jeong Min Lee

  2. Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea

    Jihyuk Lee, Ijin Joo, Dong Ho Lee, Sun Kyung Jeon & Jeong Min Lee

  3. Institute of Radiation Medicine, Seoul National University Medical Research Center Seoul National University Hospital, Seoul, South Korea

    Jeong Min Lee

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  1. Jihyuk Lee
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Correspondence to Ijin Joo.

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Lee, J., Joo, I., Lee, D.H. et al. Clinical outcomes of patients with a high alpha-fetoprotein level but without evident recurrence on CT or MRI in surveillance after curative-intent treatment for hepatocellular carcinoma. Abdom Radiol 46, 597–606 (2021). https://doi.org/10.1007/s00261-020-02707-z

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