Objectives To investigate the impact of serum α-fetoprotein (AFP) levels on survival and early recurrence after R0 resection in primary hepatocellular carcinoma (HCC).

Methods We retrospectively analyzed clinical data of 582 patients with primary HCC (male: 488, female: 94; mean age: 51 years [age range, 31-73 years]) who underwent R0 resection between January 1997 and December 2009. The 1-, 3-, and 5-year overall survival (OS) rates and the clinico-pathological factors between the AFP-negative and AFP-positive groups were compared. Risk factors of early recurrence in the AFP-positive group were further analyzed.

Results Age and histological differentiation were significantly lower in the AFP-positive group than in AFP-negative group (χ²=1 1.004, 32.293; P=0.000). In the AFP-positive group, serum γ-glutamyl transferase levels, tumor diameters, TNM stage, and early recurrence rate were higher (χ²=9.814 to 14.009, P<0.05), whereas the proportion of solitary HCC was lower (χ²=8.509, P=0.004). The 1-, 3-, and 5-year OS rates in the AFP-positive group were 80.5%, 66.9%, and 40.2%, respectively, and those in the AFP-negative group were 89.2%, 79.9%, and 50.3%, respectively (χ²=11.884, P=0.001). The 1-, 3-, and 5-year disease-free survival rates were 65.6%, 48.5%, 29.6% in the AFP-positive group and 81.7%, 63.9%, 42.1% in the AFP-negative group respectively (χ²=15.574, P=0.000). The median OS times of early recurrence and non-early recurrence were 10 and 62 months, respectively (χ²=45.013, P=0.000), and their median survival times from recurrence to death were 6 and 14 months, respectively (χ²=40.581, P=0.000). Multiple-factor analysis suggested non-solitary HCC and low histological differentiation are independent risk factors influencing early recurrence of HCC.

Conclusion Elevated preoperative serum AFP levels were indicative of early HCC recurrence.