Value of α-fetoprotein in association with clinicopathological features of hepatocellular carcinoma

Table 1 Background characteristics of 2304 patients with hepatocellular carcinoma n (%)

Variables	n = 2304
Sex
Male	1987 (86.2)
Female	317 (13.8)
Age (yr), mean ± SD	51.9 ± 12.9
AFP value (μg/L), mean ± SD	555.31 ± 546.69
HBV infection
No	429 (18.6)
Yes	1875 (81.4)
HCV infection
No	2287 (99.3)
Yes	17 (0.7)
Child-Pugh grade
A	1790 (77.7)
B	495 (21.5)
C	19 (0.8)

HCC: Hepatocellular carcinoma; AFP: α-fetoprotein; HBV: Hepatitis B virus; HCV: Hepatitis C virus.

Table 2 Serum α-fetoprotein level of different tumor related factors n (%)

Variables	n = 2304	AFP (μg/L)	P value
HBV infection			< 0.001
Yes	1875 (81.4)	573.9 ± 547.7
No	429 (18.6)	398.4 ± 522.3
Tumor size(cm)			< 0.001
≤ 5	871 (37.8)	444.9 ± 514.2
5-10	804 (34.9)	499.5 ± 536.4
≥ 10	629 (27.3)	808.4 ± 529.2
Tumor number			0.451
1	1666 (72.2)	531.9 ± 18.9
2	288 (12.5)	532.2 ± 44.7
≥ 3	350 (15.3)	556.0 ± 42.2
Vascular invasion			< 0.001
No	1714 (74.4)	502.1 ± 543.1
Yes	590 (25.6)	694.1 ± 546.9
Tumor differentiation1			0.007
High	139 (7.5)	207.3 ± 420.8
Intermediateb	963 (52.3)	527.9 ± 538.4
Low	741 (40.2)	559.2 ± 545.7
TNM staging			0.306
I	495 (21.5)	578.6 ± 549.3
II	289 (12.5)	493.3 ± 542.2
IIIA	726 (31.5)	548.6 ± 544.3
IIIB	214 (9.3)	585.3 ± 553.4
IIIC	101 (4.3)	558.9 ± 551.7
IV	479 (20.8)	534.0 ± 545.9
BCLC staging			0.008
A	869 (37.7)	506.2 ± 537.4
B	251 (10.9)	590.1 ± 551.1
C	1028 (44.6)	607.3 ± 553.3
Dd	156 (6.8)	625.7 ± 529.8
China staging			0.386
I	137 (5.9)	487.8 ± 542.2
IIa	198 (8.6)	528.8 ± 533.9
IIb	893 (38.7)	560.8 ± 545.7
III	1076 (46.7)	527.9 ± 544.8

¹We assessed 1843/2304 patients who had underwent hepatectomy or fine needle aspiration.

^bP < 0.001 vs high and low differentiation groups.

^dP < 0.001 vs stage A and B of BCLC. AFP: α-fetoprotein; HBV: Hepatitis B virus; TNM: Tumor-node-metastasis; BCLC: The Barcelona-Clinic Liver Cancer Group.

Table 3 Positive rate of patients with different tumor-related factors in four α-fetoprotein level inervals n (%)

Variables AFP (μg/L)	≤20	20-400	401-800	≥801	n = 2304	P value
HBV infection						< 0.001
Yes	507 (26.7)	441 (23.2)	126 (6.4)	801 (42.4)	1875 (81.4)
No	202 (47.0)	82 (19.2)	18 (4.3)	127 (29.5)	429 (18.6)
Tumor size (cm)						< 0.001
≤ 5	243 (27.90)	361 (41.45)	66 (7.58)	201 (23.08)	871 (37.80)
5-10	262 (32.59)	206 (25.62)	43 (5.35)	293 (36.44)	804 (34.90)
≥ 10	117 (18.60)	84 (13.35)	27 (4.29)	401 (63.75)	629 (27.30)
Tumor number						0.593
1	469 (28.15)	461 (27.67)	103 (6.18)	622 (38.00)	1666 (72.31)
2	66 (22.92)	97 (33.68)	14 (4.86)	111 (38.54)	288 (12.50)
≥ 3	87 (24.86)	93 (26.57)	19 (5.43)	151 (43.14)	350 (15.19)
Vascular invasion						< 0.001
No	510 (29.75)	498 (29.05)	101 (5.89)	605 (35.30)	1714 (74.39)
Yes	112 (19.98)	153 (25.93)	35 (5.93)	290 (49.15)	590 (25.61)
Tumor differentiation						0.012
High	57 (42.22)	60 (44.44)	5 (3.70)	16 (11.85)	135 (5.99)
Intermediate	285 (29.75)	263 (27.45)	81 (8.46)	335 (34.97)	958 (41.84)
Low	263 (35.93)	134 (18.31)	43 (5.87)	301 (41.12)	732 (32.16)
TNM staging						0.767
I	125 (25.25)	139 (28.08)	23 (4.65)	208 (42.02)	495 (21.48)
II	90 (31.14)	81 (28.03)	18 (6.23)	100 (34.60)	289 (12.54)
IIIA	197 (27.13)	201 (27.69)	50 (6.89)	278 (38.29)	726 (31.51)
IIIB	50 (28.36)	64 (29.91)	10 (4.67)	90 (42.06)	214 (9.29)
IIIC	27 (26.73)	28 (27.72)	5 (4.95)	41 (40.59)	101 (4.38)
IV	133 (27.77)	138 (28.81)	30 (6.26)	178 (37.16)	479 (20.79)
BCLC staging						< 0.001
A	261 (30.03)	266 (30.61)	56 (6.44)	286 (32.91)	869 (37.72)
B	59 (23.51)	78 (31.08)	15 (5.98)	99 (39.44)	251 (10.89)
C	271 (23.36)	272 (24.46)	53 (5.16)	432 (42.02)	1028 (44.62)
D	31 (19.87)	35 (22.44)	12 (7.69)	78 (50.00)	156 (6.77)
China staging						0.124
I	34 (24.82)	54 (39.42)	3 (2.19)	46 (33.58)	137 (5.95)
IIa	48 (24.24)	70 (35.35)	7 (3.54)	73 (36.87)	198 (8.59)
IIb	231 (25.87)	237 (26.54)	65 (7.28)	360 (40.31)	893 (38.76)
III	309 (28.72)	290 (29.95)	61 (5.67)	416 (38.66)	1078 (46.70)

Patients were divided into four groups according to the serum α-fetoprotein (AFP) level, they were ≤ 20, 20-400, 401-800 and ≥ 801 μg/L, the positive rate of patients in each interval of AFP were calculated. HBV: Hepatitis B virus; TNM: Tumor-node-metastasis; BCLC: The Barcelona-Clinic Liver Cancer Group.

Table 4 Binary logistic regression analysis of tumor related factors elevating the level of α-fetoprotein (> 400 μg/L)

Variables	P value	Odds ratio (95%CI)
HBV infection	0.156	4.162 (0.991-16.557)
Vascular invasion	0.060	3.963 (0.529-7.384)
≤ 5	-	-
5-10	0.341	0.862 (0.317-9.284)
≥ 10	0.012	5.215 (1.426-13.151)
Tumor number
1	-	-
2	0.513	0.487 (0.056-4.204)
≥ 3	0.122	0.146 (0.013-1.671)
Tumor differentiation
High	-	-
Intermediate	0.017	3.951 (1.501-9.917)
Low	0.006	6.362 (2.891-15.382)

The level status of α-fetoprotein (> 400 μg/L) was used as a dependent variable. HBV: Hepatitis B virus.