Table 5.

Prognostic value of baseline and increase of alpha-fetoprotein for hepatocellular carcinoma in patients who underwent resection or transplantation

Ref.		Patient (n)	Study design	Treatment	Level values	Impact value	Comments
Liu et al[57]	AFP	2034	Retrospective	Resection (79.2%) NA (20.8)	High AFP levels (> 20 μg/L)	Large tumors (≥ 10 cm)	This large cohort study showed that High AFP level was associated with poor prognosis and poor clinicopathological features of HCC
						Higher vascular invasion
						Lower differentiated tumor
Wang et al[139]		160	Retrospective	Resection	High AFP level (> 4000 UI/L)	Shorter median TTR	In this study, the value of AFP levels to predict recurrence is limited since only a few numbers of patients (9%) have AFP level higher than the cutoff level
Ma et al[58]		108	Retrospective	Resection	High AFP level (> 20 ng/mL)	Lower differentiated tumor	This study demonstrated the negative impact of high AFP levels on surgery benefit and the need to closely screen patients after resection for recurrence
						Higher vascular invasion
						Higher postoperative 2-yr recurrence rate
						Lower 24-mo survival rate
Ikai et al[59]		12118	Japanese nationwide	Resection	High AFP level (≥ 20 ng/mL)	Worsen OS after surgery	This large cohort study showed better outcome of patient resected for HCC in the last decade but the persistence of the negative impact of high AFP level on prognosis
			Analysis
			Comparative study
Vibert et al[60]		153	Retrospective	LT	AFP level increase > 15 μg/L per month	Lower OS	This study showed the negative impact on the outcome of AFP levels increases in patients undergoing LT
						Lower RFS
						Higher recurrence rate
Hakeem et al[61]		12159	Systemic review	LT	AFP > 1000 ng/mL (based on the majority of study included in the review)	Poorer OS	The authors stressed the poor quality of previous studies and the need for high-quality evidence on outcomes to use AFP levels as a prognostic indicator for patients undergoing LT
						Poorer DFS
						Higher vascular invasion
						Poorer differentiated tumor
Duvoux et al[62]		972	Prospective/retrospective	LT	High AFP level	Tumor recurrence	A new score model including AFP level was proposed to select patients for LT
						Vascular invasion
						Poor differentiation

AFP: Alpha-fetoprotein; DFS: Disease-free survival; HCC: Hepatocellular carcinoma; LT: Liver transplantation; NA: Not available; RFS: Recurrence-free survival; TTR: Time to recurrence.