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Effect of pre- and post-treatment α-fetoprotein levels and tumor size on survival of patients with hepatocellular carcinoma treated by resection, transarterial chemoembolization or radiofrequency ablation: a retrospective study

Adriana Toro1, Annalisa Ardiri2, Maurizio Mannino1, Maria Concetta Arcerito3, Giovanni Mannino4, Filippo Palermo5, Gaetano Bertino2 and Isidoro Di Carlo16*

Author Affiliations

1 Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of Catania, Cannizzaro Hospital, Via Messina, 829, Catania 95126, Italy

2 Department of Internal Medicine and Systemic Disease, Hepatology Unit, University of Catania, S. Marta Hospital, Catania, Italy

3 University of Catania, Catania, Italy

4 Infectious Diseases Unit, Cannizzaro Hospital, Catania, Italy

5 Department of Internal and Specialist Medicine, Section of Infectious Disease, University of Catania, Garibaldi Hospital, Catania, Italy

6 Department of Surgery, Hamad Medical Corporation, Doha, Qatar

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BMC Surgery 2014, 14:40  doi:10.1186/1471-2482-14-40

Published: 4 July 2014



We evaluated treatment modalities and survival in patients with hepatocellular carcinoma (HCC), by pre-treatment and 3-month post-treatment serum alpha-fetoprotein (AFP) levels and pre-treatment tumor diameters.


We retrospectively reviewed 57 patients treated for HCC in our department from January 2002 to December 2012, including their sex, type of hepatitis, Child class, pre-treatment tumor size, pre-treatment levels of albumin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyltransferase (GGT), red blood cells, hemoglobin, and total bilirubin, pre- and 3-month post-treatment serum AFP, and treatment modality (transarterial chemoembolization, resection or radiofrequency ablation). Survival was analyzed at 1, 3, and 5 years after treatment.


The 57 patients included 44 men and 13 women, of whom 44 had hepatitis C virus (HCV) infection, 3 had hepatitis B virus (HBV) infection, 3 had both HBV and HCV infection, 1 had both HBV and hepatitis D virus infection, and 3 had alcohol-related liver cirrhosis. Both pre- and post-treatment serum AFP levels significantly correlated with recurrent tumor size (P < 0.05 for both). Pre-treatment tumor size did not correlate with recurrent tumor size. Patients who underwent hepatic resection survived significantly longer than those who underwent transarterial chemoembolization or radiofrequency ablation (P < 0.05).


Serum AFP level is useful in diagnosing tumor recurrence and predicting prognosis in HCC patients treated by hepatic resection, transarterial chemoembolization, and radiofrequency ablation. Hepatic resection remains the treatment of choice for HCC in suitable patients.

Hepatocellular carcinoma; Hepatic resection; Transarterial chemoembolization; Radiofrequency ablation; Alpha-fetoprotein; Tumor size; Survival