To investigate the prognostic value of preoperative serum level of cancer antigen (CA) 125 in hepatocellular carcinoma (HCC) patients with a low level of AFP after R0 resection.

Clinical data of 427 HCC patients who underwent R0 resection in the Affiliated Hospital of Qingdao University from January 2009 to December 2015 were retrospectively analyzed. Among them, 366 patients were male and 61 female, aged (57±10) years on average, with AFP≤200 μg/L. The informed consents of all patients were obtained and the local ethical committee approval was received. The serum levels of CA125 and AFP were detected in all patients before operation. According to the level of CA125, all patients were divided into normal CA125 (n=392) and elevated CA125 groups (n=35). The factors affecting preoperative serum level of CA125 were analyzed by Chi-square test. The survival analysis was performed by Kaplan-Meier method and Log-rank test.

The proportion of elevated CA125 before operation in women and patients with maximum tumor diameter >5 cm significantly increased (χ²=4.067, 29.006; P<0.05). The 1-, 2-, and 5-year tumor-free survival rates in normal CA125 group were 84.9%, 69.9%, 43.9%, and 61.8%, 49.7%, 16.5% in elevated CA125 group. The tumor-free survival of normal CA125 group was significantly better compared with that of elevated CA125 group (χ²=8.593, P<0.05). The 1-, 2-, and 5-year overall survival rates in normal CA125 group were 97.4%, 90.6%, 67.2%, and 91.4%, 65.7%, 44.5% in elevated CA125 group, accordingly. The overall survival of normal CA125 group was significantly better compared with that of elevated CA125 group (χ²=10.478, P<0.05).

The elevation of preoperative CA125 is a predictor of high recurrence rate and low survival in HCC patients with a low level of AFP after R0 resection. The elevation of CA125 is correlated with gender and tumor diameter.