Association of serum AFP trajectories and hepatocellular carcinoma outcomes after hepatic arterial infusion chemotherapy: A longitudinal, multicenter study

Abstract

AimThis study aims to investigate α‐fetoprotein (AFP) trajectories for prediction of survival outcomes after hepatic arterial infusion chemotherapy (HAIC) treatment in large hepatocellular carcinoma (HCC).MethodsFrom May 2014 to June 2020, 889 eligible patients with large HCC underwent HAIC were retrospectively enrolled from five hospitals. A latent class growth mixed (LCGM) model was applied to distinguish potential AFP level dynamic changing trajectories. Inverse‐probability‐of‐treatment weighted (IPTW) analyses were performed to eliminate unmeasured confounders through marginal structural models. Multivariate Cox proportional hazard regression analyses were used to determine the overall survival (OS) in patients with large HCC. Performance of these serum markers for survival prediction was compared by areas under receiver operating characteristic analysis with the Delong test.ResultsThe median follow‐up time was 23.7 (interquartile range, 3.8–115.3). A total of 1009 patients with large HCC, who underwent HAIC with AFP repeatedly measured 3–10 times, were enrolled in the study. Three distinct trajectories of these serum AFP were identified using the LCGM model: high stable (37.0%; n = 373), low stable (15.7%; n = 159), and sharp‐falling (47.3%; n = 477). Multivariate Cox proportional hazard regression analyses found that ALBI stage 2–3, BCLC‐C stage and high‐stable AFP trajectories were associated with OS. AFP trajectories yield the optimal predictive performance in all risk factors.ConclusionsThe AFP trajectories based on longitudinal AFP change showed outstanding performance for predicting survival outcomes after HAIC treatment in large HCC, which provide a potential monitoring tool for improving clinical decision‐making.

Research Progress in Predicting Hepatocellular Carcinoma with Portal Vein Tumour Thrombus in the Era of Artificial Intelligence

“…This also provides a potential monitoring tool for improving clinical decision-making. 14 Stefano Mazza et al employed multivariate COX regression analysis to categorize the AFP threshold values of 266 HCC patients undergoing radical treatment, utilizing AFP values of 20, 200, 400, and 1000 ng/mL as reference points. An AFP level of ≥1000 ng/mL was found to be correlated with a decrease in overall survival (1-year OS: 67% vs 88%, 5-year OS: 1% vs 43%; p = 0.005).…”