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

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 (Time(AFP-Imaging recurrence)) was estimated using the Kaplan-Meier method. Cox regression analyses were performed to assess the associated factors with Time(AFP-Imaging recurrence). Results The median Time(AFP-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 Time(AFP-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 Time(AFP-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.

Automated summary

In patients with high posttreatment AFP without evident recurrence on CT or MRI after curative-intent treatment of HCC, there may be a frequent progression to imaging-evident recurrence, indicating a need for extensive diagnostic workup or close monitoring in high-risk patients.