Extrahepatic metastasis risk of hepatocellular carcinoma based on a-fetoprotein and tumor staging parameters at cross-sectional imaging

Takeshi Yokoo, Amish D. Patel, Naama Lev-Cohain, Amit G. Singal, Adam C. Yopp, Ivan Pedrosa

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Extrahepatic metastases have important implications in the clinical management of hepatocellular carcinoma (HCC). The purpose of this study was to validate tumor staging parameters and serum AFP as risk factors of HCC metastasis. Patients and methods: In this retrospective case–control study, patients with a new diagnosis of HCC (N=236), median age 57 years (range 28-89 years), and male-to-female ratio of 183/53 were divided into a “no-met” group (N=101) without extrahepatic metastasis or a “met” group with extrahepatic metastases (N=135). Metastasis risk factors based on tumor staging parameters (size, number, infiltration, and vascular invasion) and serum AFP level were calculated as odds ratio (OR). Sensitivities of the risk factors as metastasis screening tests were also calculated. Results: AFP >400 µg/mL, index tumor size >5 cm, and vascular invasion individually had strong association with metastasis, with OR (95% confidence interval) of 11.5 (5.9-22.1), 17.7 (9.0-34.8), and 18.9 (8.2-43.9), respectively, but with moderate sensitivities as metastasis screening tests, with 71.9% (65.7-77.3), 75.6% (69.6-80.7), and 58.5% (52.1-64.7), respectively. Composite multiparametric criteria, eg, a logical union of 1) tumor size outside of Milan criteria, 2) AFP threshold >35 µg/mL, and 3) vascular invasion, had excellent OR up to 55.6 (13.0–237.1) with screening sensitivity 98.5% (95.8-99.6). Conclusion: Serum AFP, tumor size, and vascular invasion are strongly associated with extrahepatic metastasis of HCC, especially when combined into a multiparametric metastasis prediction criterion.

Original languageEnglish (US)
Pages (from-to)503-511
Number of pages9
JournalCancer Management and Research
Volume9
DOIs
StatePublished - Oct 16 2017

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Fetal Proteins
Neoplasm Staging
Hepatocellular Carcinoma
Neoplasm Metastasis
Blood Vessels
Odds Ratio
Serum
Neoplasms
Retrospective Studies
Confidence Intervals

Keywords

  • Hepatocellular carcinoma
  • Metastasis
  • Risk factor
  • Stage
  • α-fetoprotein

ASJC Scopus subject areas

  • Oncology

Cite this

@article{e767d5b09f714c329985d71f3e00b2f3,
title = "Extrahepatic metastasis risk of hepatocellular carcinoma based on a-fetoprotein and tumor staging parameters at cross-sectional imaging",
abstract = "Background: Extrahepatic metastases have important implications in the clinical management of hepatocellular carcinoma (HCC). The purpose of this study was to validate tumor staging parameters and serum AFP as risk factors of HCC metastasis. Patients and methods: In this retrospective case–control study, patients with a new diagnosis of HCC (N=236), median age 57 years (range 28-89 years), and male-to-female ratio of 183/53 were divided into a “no-met” group (N=101) without extrahepatic metastasis or a “met” group with extrahepatic metastases (N=135). Metastasis risk factors based on tumor staging parameters (size, number, infiltration, and vascular invasion) and serum AFP level were calculated as odds ratio (OR). Sensitivities of the risk factors as metastasis screening tests were also calculated. Results: AFP >400 µg/mL, index tumor size >5 cm, and vascular invasion individually had strong association with metastasis, with OR (95{\%} confidence interval) of 11.5 (5.9-22.1), 17.7 (9.0-34.8), and 18.9 (8.2-43.9), respectively, but with moderate sensitivities as metastasis screening tests, with 71.9{\%} (65.7-77.3), 75.6{\%} (69.6-80.7), and 58.5{\%} (52.1-64.7), respectively. Composite multiparametric criteria, eg, a logical union of 1) tumor size outside of Milan criteria, 2) AFP threshold >35 µg/mL, and 3) vascular invasion, had excellent OR up to 55.6 (13.0–237.1) with screening sensitivity 98.5{\%} (95.8-99.6). Conclusion: Serum AFP, tumor size, and vascular invasion are strongly associated with extrahepatic metastasis of HCC, especially when combined into a multiparametric metastasis prediction criterion.",
keywords = "Hepatocellular carcinoma, Metastasis, Risk factor, Stage, α-fetoprotein",
author = "Takeshi Yokoo and Patel, {Amish D.} and Naama Lev-Cohain and Singal, {Amit G.} and Yopp, {Adam C.} and Ivan Pedrosa",
year = "2017",
month = "10",
day = "16",
doi = "10.2147/CMAR.S147097",
language = "English (US)",
volume = "9",
pages = "503--511",
journal = "Cancer Management and Research",
issn = "1179-1322",
publisher = "Dove Medical Press Ltd.",

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TY - JOUR

T1 - Extrahepatic metastasis risk of hepatocellular carcinoma based on a-fetoprotein and tumor staging parameters at cross-sectional imaging

AU - Yokoo, Takeshi

AU - Patel, Amish D.

AU - Lev-Cohain, Naama

AU - Singal, Amit G.

AU - Yopp, Adam C.

AU - Pedrosa, Ivan

PY - 2017/10/16

Y1 - 2017/10/16

N2 - Background: Extrahepatic metastases have important implications in the clinical management of hepatocellular carcinoma (HCC). The purpose of this study was to validate tumor staging parameters and serum AFP as risk factors of HCC metastasis. Patients and methods: In this retrospective case–control study, patients with a new diagnosis of HCC (N=236), median age 57 years (range 28-89 years), and male-to-female ratio of 183/53 were divided into a “no-met” group (N=101) without extrahepatic metastasis or a “met” group with extrahepatic metastases (N=135). Metastasis risk factors based on tumor staging parameters (size, number, infiltration, and vascular invasion) and serum AFP level were calculated as odds ratio (OR). Sensitivities of the risk factors as metastasis screening tests were also calculated. Results: AFP >400 µg/mL, index tumor size >5 cm, and vascular invasion individually had strong association with metastasis, with OR (95% confidence interval) of 11.5 (5.9-22.1), 17.7 (9.0-34.8), and 18.9 (8.2-43.9), respectively, but with moderate sensitivities as metastasis screening tests, with 71.9% (65.7-77.3), 75.6% (69.6-80.7), and 58.5% (52.1-64.7), respectively. Composite multiparametric criteria, eg, a logical union of 1) tumor size outside of Milan criteria, 2) AFP threshold >35 µg/mL, and 3) vascular invasion, had excellent OR up to 55.6 (13.0–237.1) with screening sensitivity 98.5% (95.8-99.6). Conclusion: Serum AFP, tumor size, and vascular invasion are strongly associated with extrahepatic metastasis of HCC, especially when combined into a multiparametric metastasis prediction criterion.

AB - Background: Extrahepatic metastases have important implications in the clinical management of hepatocellular carcinoma (HCC). The purpose of this study was to validate tumor staging parameters and serum AFP as risk factors of HCC metastasis. Patients and methods: In this retrospective case–control study, patients with a new diagnosis of HCC (N=236), median age 57 years (range 28-89 years), and male-to-female ratio of 183/53 were divided into a “no-met” group (N=101) without extrahepatic metastasis or a “met” group with extrahepatic metastases (N=135). Metastasis risk factors based on tumor staging parameters (size, number, infiltration, and vascular invasion) and serum AFP level were calculated as odds ratio (OR). Sensitivities of the risk factors as metastasis screening tests were also calculated. Results: AFP >400 µg/mL, index tumor size >5 cm, and vascular invasion individually had strong association with metastasis, with OR (95% confidence interval) of 11.5 (5.9-22.1), 17.7 (9.0-34.8), and 18.9 (8.2-43.9), respectively, but with moderate sensitivities as metastasis screening tests, with 71.9% (65.7-77.3), 75.6% (69.6-80.7), and 58.5% (52.1-64.7), respectively. Composite multiparametric criteria, eg, a logical union of 1) tumor size outside of Milan criteria, 2) AFP threshold >35 µg/mL, and 3) vascular invasion, had excellent OR up to 55.6 (13.0–237.1) with screening sensitivity 98.5% (95.8-99.6). Conclusion: Serum AFP, tumor size, and vascular invasion are strongly associated with extrahepatic metastasis of HCC, especially when combined into a multiparametric metastasis prediction criterion.

KW - Hepatocellular carcinoma

KW - Metastasis

KW - Risk factor

KW - Stage

KW - α-fetoprotein

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U2 - 10.2147/CMAR.S147097

DO - 10.2147/CMAR.S147097

M3 - Article

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JO - Cancer Management and Research

JF - Cancer Management and Research

SN - 1179-1322

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