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ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 39 Issue 3
Mar.  2023
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Article Navigation >  Journal of Clinical Hepatology  > 2023  >  39(3): 599-605

Value of a scoring system based on the serum levels of alpha-fetoprotein and alkaline phosphatase in predicting the prognosis of patients with resectable hepatocellular carcinoma

DOI: 10.3969/j.issn.1001-5256.2023.03.017
  • 1.

    The First Central Clinical College of Tianjin Medical University, Tianjin 300192, China

  • 2.

    Department of Oncology, Baoding First Hospital, Baoding, Hebei 071000, China

  • 3.

    Department of Hepatobiliary Surgery, Tianjin First Central Hospital, Tianjin 300192, China

  • 4.

    Department of Anesthesiology, Baoding First Central Hospital, Baoding, Hebei 071000, China

Research funding:

Tianjin Science and Technology Plan Project (19ZXDBSY00010);

Baoding Science and Technology Plan Project (2241ZF219)

More Information
  • Corresponding author: ZHANG Yamin, 13802122219@163.com (ORCID: 0000-0002-3724-6907)
  • Received Date: 2022-08-02
  • Accepted Date: 2022-09-12
  • Published Date: 2023-03-20
    Abstract
  •   Objective  To establish a scoring system based on the preoperative serum levels of alpha-fetoprotein (AFP) and alkaline phosphatase (ALP), and to investigate its value in predicting the prognosis of patients with resectable hepatocellular carcinoma (HCC).  Methods  A retrospective analysis was performed for 154 HCC patients who underwent hepatectomy as the initial treatment in Tianjin First Central Hospital from January 2016 to August 2019. The receiver operating characteristic (ROC) curve was used to determine the optimal cut-off values of serum AFP and ALP; the Kaplan-Meier curve and the log-rank test were used for survival analysis to evaluate the relationship between the AFP-ALP score and disease-free survival (DFS); univariate and multivariate Cox regression analyses were used to identify the independent prognostic factors for HCC patients. The independent samples t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups.  Results  The ROC curve analysis showed that serum AFP had an optimal cut-off value of 250.0 ng/mL and an area under the ROC curve (AUC) of 0.674 (95% confidence interval [CI]: 0.580-0.767) in predicting DFS, while serum ALP had an optimal cut-off value of 95.5 U/L and an AUC of 0.745 (95% CI: 0.652-0.838). The survival analysis showed that high preoperative serum levels of AFP (≥250.0 ng/mL) and ALP (≥95.5 U/L) were significantly associated with the poor prognosis of HCC patients (P < 0.001). Based on the AFP-ALP score, all HCC patients were further divided into 0-point group (AFP < 250.0 ng/mL and ALP < 95.5 U/L), 1-point group (AFP≥250.0 ng/mL, ALP < 95.5 U/L; or AFP < 250.0 ng/mL, ALP ≥95.5 U/L), and 2-point group (AFP≥250.0 ng/mL and ALP≥95.5 U/L). The survival curves showed that the 0-, 1-, and 2-point groups had a median DFS of 60.0 (56.7-67.3) months, 20.0 (1.4-36.6) months, and 13.0(7.9-18.0) months, respectively, and there were significant survival differences between the three groups (P < 0.05). Serum AFP-ALP score (1 point vs 0 point: hazard ratio [HR]=4.060, 95% confidence interval [CI]: 2.050-8.039, P < 0.001; 2 points vs 0 point: HR=4.583, 95%CI: 2.385-8.805, P < 0.001) was an independent prognostic factor for HCC patients.  Conclusion  The scoring system based on the serum levels of AFP and ALP can effectively identify HCC patients with poor prognosis, and therefore, it might be used as a simple and reliable tool for prognostic assessment in the clinical treatment of HCC.

     

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