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

Authors Yokoo T, Patel AD, Lev-Cohain N, Singal AG, Yopp AC, Pedrosa I

Received 24 July 2017

Accepted for publication 20 September 2017

Published 16 October 2017 Volume 2017:9 Pages 503—511


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Nakshatri

Takeshi Yokoo,1 Amish D Patel,1 Naama Lev-Cohain,1 Amit G Singal,2 Adam C Yopp,3 Ivan Pedrosa1

1Department of Radiology, 2Department of Internal Medicine, 3Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA

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 mg/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 mg/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, risk factor, α-fetoprotein, stage, metastasis

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