ORIGINAL ARTICLE Alkaline Phosphatase: Does it have a Role in Predicting Hepatocellular Carcinoma Recurrence? Ming-Chin Yu & Kun-Ming Chan & Chen-Fang Lee & Yun-Shien Lee & Firas Zahr Eldeen & Hong-Shiue Chou & Wei-Chen Lee & Miin-Fu Chen Received: 16 December 2010 / Accepted: 4 April 2011 / Published online: 4 May 2011 # 2011 The Society for Surgery of the Alimentary Tract Abstract Backgrounds Surgical resection remains the first line of treatment for earlier stages of hepatocellular carcinoma (HCC), and it offers the best prognosis for long-term survival. Nevertheless, the recurrence rates after resection are still high in reports. Therefore, it is still essential to explore any potential prognostic factors to attain relatively longer-term survival of HCC patients. Materials and Methods In the period from 1983 to 2005, 1,685 patients who underwent hepatectomy at Chang Gung Memorial hospital were enrolled in the study, and their clinicopathological data were retrospectively reviewed for survival analysis. Results The 1-, 3-, 5-, and 10-year disease-free survival (DFS) rates in this series were 60.3%, 39.7%, 31.3%, and 24.0%, respectively, whereas the 1-, 3-, 5-, and 10-year overall survival (OS) rates were 80.1%, 59.1%, 46.6%, and 27.7%, respectively. Gross vascular invasion, tumor status, lymph node involvement, satellite lesion, positive surgical margin, alkaline phosphatase (ALP), albumin, presence of cirrhosis, and Child grade B or C were independent prognostic factors for prediction of DFS; while α-fetoprotein, ALP, surgical factors, including complications, blood transfusion, positive resection margin, and tumor characters including tumor status, vascular invasion, and lack of tumor encapsulation were found to be independent predicting factors for OS, as determined by Cox regression analysis. Interestingly, we found that preoperative level of ALP was one of the most important independent predictors of recurrence, even more important that α-fetoprotein (AFP) as we noticed that elevation of ALP above (82 U/L) predicted poor prognosis in patients where AFP levels was less than 66 ng/ml. It is worth to mention that ALP was statistically related to other liver function tests, but not tumor characters by hierarchical clustering; which means that we were able to correlate ALP with prognosis statistically, but not with pathological criteria of the tumor; to elucidate these finding, further basic science research is required. Conclusion ALP among liver function tests, in addition to other tumor characters were independent factors for DFS and OS; our results suggest that preoperative ALP levels could be utilized to monitor and predict recurrence in high risk HCC patients. Keywords Hepatocellular carcinoma . Hepatectomy . Alkaline phosphatase . Prognosis Introduction Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and accounts for 5.6% of all human cancers. Primary liver cancer is also the third leading cause of cancer death with yearly fatality ratio of This paper was presented at the minioral session of 9th World Congress of the International Hepato-Pancreato-Biliary Association, 2010; April 18–22, 2010 at Buenos Aires (Ref. No. 7340772). There is no commercial interest in the study and the financial support is from Chang Gung Medical Research funding, CMRP 361522. M.-C. Yu : K.-M. Chan : C.-F. Lee : F. Z. Eldeen : H.-S. Chou : W.-C. Lee (*) : M.-F. Chen Department of Surgery, Chang Gung Memorial Hospital, Linkou No. 5, Fu-Hsing Street, Kuei Shan Hsiang, Taoyuan county 333, Taiwan e-mail: weichen@cgmh.org.tw M.-C. Yu Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan Y.-S. Lee Genomic Medicine Research Core Laboratory, Chang Gung Memorial Hospital, Taoyuan, Taiwan J Gastrointest Surg (2011) 15:1440–1449 DOI 10.1007/s11605-011-1537-3