Prognostic impact of surgical margins for hepatocellular carcinoma according to preoperative alpha-fetoprotein level

Background: HCC are known to have satellite nodules and microvascular invasions requiring sufficient margins. An alpha-fetoprotein (AFP) level >100 ng/mL is associated with worse pathological features in HCC. In practice, large resection margins, particularly >1 cm, are infrequently retrieved on the specimens. Methods: 397 patients from 5 centres were included from 2012 to 2017. The primary endpoint was time-to-recurrence in relation to AFP level (> or <100 ng/ml) as well as surgical margins (> or <1 cm). The secondary endpoint was overall survival (OS). Results: The median follow-up was 25 months. In Low AFP group, median time to recurrence (TTR) for patients with margins <1 cm was 36 months and for patients with margins >= 1 cm was 34 months (p = 0.756), and overall survival (OS) was not significantly different according to margins (p = 0.079). In HighAFP group, patients with margins <1 cm had a higher recurrence rate than patients with margins >= 1 cm (p = 0.016): median TTR for patients with margins <1 cm was 8 months whereas it was not reached for patients with margins >= 1 cm. Patients with margins <1 cm had a significantly worse OS compared to the patients with margins >= 1 cm (p = 0.043). Conclusion: Preoperative AFP level may help determine margins to effectively treat high AFP tumours. For low-AFP tumours, margins didn't have an impact on TTR or OS.

Automated summary

This study found that preoperative AFP levels can guide the necessary resection margins for treating HCC with high AFP levels. For HCC with low AFP levels, the resection margins did not affect the time to recurrence or overall survival.