OBJECTIVETo investigate the impact of serum α-fetoprotein (AFP) level on survival and short-term recurrence after R0 resection in primary hepatocellular carcinoma (HCC).

METHODSThe clinical data of 582 cases of primary HCC underwent R0 resection from January 1997 to December 2009 was analyzed retrospectively. There were 488 male and 94 female patients whose average age was 51 years (ranging from 31 to 73 years). The survival rate of 1-, 3- and 5-year and clinopathological factors between the AFP-negative group and AFP-positive group were compared. The risk factors of short-term recurrence after R0 resection of HCC patients in AFP-positive group were further analyzed.

RESULTSThe age and histological differentiation in AFP-positive group were significantly lower than the AFP-negative group (χ(2) = 11.004, 32.293; P = 0.000). Otherwise the serum γ-glutamyl transferase level, diameter of tumor, TNM stage and short-term recurrence were higher than the AFP-negative group (χ(2) = 9.814 to 14.009, P < 0.05) , and solitary HCC in AFP-positive group was less than AFP-negative group (χ(2) = 8.509, P = 0.004). Survival analysis showed that overall survival rate of 1-, 3- and 5- year were 80.5%, 53.9%, 40.2% and 89.2%, 69.8%, 50.3% in the AFP-positive group and AFP-negative group, respectively (χ(2) = 11.884, P = 0.001), and the disease-free survival rate of 1-, 3- and 5- year were 65.6%, 38.4%, 29.6% and 81.7%, 51.0%, 42.1% (χ(2) = 15.574, P = 0.000). The median overall survival time of short-term recurrence and not short-term recurrence were 10 months and 62 months, respectively (χ(2) = 45.013, P = 0.000). The median survival time from recurrence to death were 6 months and 14 months, respectively (χ(2) = 40.581, P = 0.000). Multiple-factor analysis suggested that non-solitary HCC and histological low differentiation are independent risk factors which influence short-term recurrence of HCC patients.

CONCLUSIONThe increase of preoperative serum AFP level suggests the potency of HCC short-term recurrency.