To investigate the clinical characteristics and prognostic factors in intrahepatic cholangiocarcinoma (ICC) patients with positive alpha-fetoprotein (AFP).

Clinical data of 57 patients with ICC in the Third Affiliated Hospital of Sun Yat-sen University from September 2004 to December 2013 were analyzed retrospectively. The informed consents of all patients were obtained and the ethical committee approval was received. There were 34 males and 23 females with an average age of (52±13) years old. According to serum AFP test result after admission in hospital, the patients were divided into AFP positive group (n=16) and AFP negative group (n=41). The difference of clinicopathological factors between two groups such as age, gender, hepatitis B surface antigen (HBsAg), liver cirrhosis, biliary lesions, preoperative carbohydrate antigen 19-9 (CA19-9), surgical procedure, metastastic lymph nodes, histological differentiation degree were compared by t-test , Chi-square test or Fisher's exact probability test. The patients were followed up and the survival of two groups was recorded. Prognostic factors analysis was conducted by Log-rank test and Cox proportional hazards regression model.

Male patients accounted for 94% (15/16) in AFP positive group, which was significantly higher than that in AFP negative group [46% (19/41)] (χ²=10.747, P<0.05). Patients complicated with liver cirrhosis accounted for 88% (14/16) , which was significantly higher than that in AFP negative group [37% (15/41)] (χ²=11.937, P<0.05). No patients were complicated with biliary lesions in AFP positive group but in AFP negative group, 12 cases were complicated with biliary lesions, where significant difference was observed between two groups (P<0.05). Surgical procedure was the independent risk factor for patients in AFP positive group. Patients undergoing radical resection had better prognosis (RR=26.813, P<0.05).

ICC patients with positive AFP are mostly complicated with liver cirrhosis but a low incidence of biliary lesions. Surgical procedure is the independent risk factor for the prognosis. Radical resection is an effective way to improve the prognosis of ICC patients with positive AFP.