Alpha-fetoprotein response correlates with EASL response and survival in solitary hepatocellular carcinoma treated with transarterial therapies: A subgroup analysis

Abstract

Background and Aims Alpha-fetoprotein (AFP) is a universally recognized tumor marker in hepatocellular carcinoma (HCC). Its utility in assessing response to treatment remains controversial. We sought to study the: a) correlation between AFP response and imaging response, and b) ability of AFP, EASL and WHO response to predict survival outcomes in patients with solitary HCC. Methods 629 HCC patients were treated with transarterial locoregional therapies over an 11-year period. To eliminate confounding factors, we included patients with single tumors, baseline AFP≥200 ng/mL, and no extrahepatic disease; this identified our study cohort of 51 patients. AFP response was defined as >50% decrease from baseline; this was correlated to EASL and WHO response criteria by Kappa agreement, Pearson correlation and receiver operating curves. Survival analyses were performed by Landmark, risk-of-death and Mantel-Byar methodologies. None of the patients received sorafenib. Results Three months post-treatment, AFP and EASL response correlated well (Kappa: 0.83; Pearson: 0.84); the sensitivity, specificity, positive and negative predictive values of AFP in predicting EASL response at 3 months were 96.6%, 85.7%, 92.3% and 93.3% respectively. Correlation with WHO response was low. From the 3-month landmark, WHO, EASL and AFP responders survived longer than nonresponders (P=0.006, 0.0001 and <0.0001 respectively). The risk of death was lower for EASL and AFP responders by both risk-of-death and Mantel-Byar methodologies (P<0.05). Conclusion Response by AFP and EASL are predictors of survival outcome in patients with solitary HCC. AFP correlates with imaging response assessment by EASL guidelines. Achieving AFP response should be one of the therapeutic intents of locoregional therapies.

The ART of decision making: Retreatment with transarterial chemoembolization in patients with hepatocellular carcinoma

“…Prior the second TACE, most patients had Child-Pugh A cirrhosis (n ¼ 69, 62%). Overall, the median number of TACE interventions was 3 (range [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. The median time interval between the first and second TACE was 42 days (range 26-85).…”

“…12 We formed three AFP groups for univariate analysis: pre-TACE-1 AFP !200 kU/L with response versus pre-TACE-1 AFP !200 kU/L and no response versus pre-TACE-1 AFP levels <200 kU/L.…”

“…[10][11][12] Finally, deterioration of liver function after TACE may negatively impact the patient prognosis and liver function may further worsen after repeated TACE sessions or even obviate any consequent antitumor treatment.…”

Evaluation of the mRECIST and α-Fetoprotein Ratio for Stratification of the Prognosis of Advanced-Hepatocellular-Carcinoma Patients Treated with Sorafenib

“…α-fetoprotein (AFP) and des-γ-carboxy prothrombin (DCP)] [12,13,14,15,16]. In this regard, the response to therapy and the prognosis for patients with HCC are reported to correlate with changes in AFP (before and after treatment) [17,18,19,20,21]. To our knowledge, however, there is little or no information on the correlation between prognosis and changes in tumor markers and the treatment with sorafenib.…”

GALNT14 genotype, α-fetoprotein and therapeutic side effects predict post-chemotherapy survival in patients with advanced hepatocellular carcinoma

“…In addition, the AFP level has been considered as an important predictor of postoperative HCC recurrence and metastasis (20,21). In patients with advanced HCC treated with either sorafenib, transarterial chemoembolization, hepatic artery infusional chemotherapy or concurrent chemoradiotherapy, an early reduction of AFP was found to be a predictor of positive outcome (22)(23)(24)(25). Furthermore, the early elevation of AFP was shown to be a predictor of unfavorable outcome in patients with advanced HCC treated with sorafenib (26).…”