Elevated alpha-fetoprotein affects the long-term prognosis after hepatectomy in patients with hepatitis B-related intrahepatic cholangiocarcinoma

Abstract

This study investigates the prognostic significance of alpha-fetoprotein (AFP) in hepatitis B virus-related intrahepatic cholangiocarcinoma (HBV-ICC), given that AFP — though commonly used for hepatocellular carcinoma — is sometimes elevated in HBV-ICC, yet its clinical relevance remains unclear. The research retrospectively analyzed 839 HBV-ICC patients who underwent curative hepatectomy, categorizing them into AFP-positive (≥ 20 ng/mL) and AFP-negative groups. Using propensity score matching and inverse probability of treatment weighting to reduce bias, the study compared overall survival (OS) and time to recurrence (TTR). Results showed that AFP-positive patients had poorer liver function and more aggressive tumor characteristics, including higher rates of cirrhosis, microvascular invasion, and satellite nodules. Across both unadjusted and adjusted cohorts, elevated AFP was significantly associated with worse OS and earlier recurrence. Multivariate Cox analysis identified AFP as an independent predictor of poor prognosis. While CA19-9 alone demonstrated limited predictive value, its combination with AFP improved prognostic accuracy. The study concludes that elevated serum AFP independently predicts adverse survival and recurrence outcomes in HBV-ICC patients after curative resection, and combining AFP with CA19-9 enhances prognostic stratification, supporting AFP as a practical biomarker for postoperative risk assessment.