Tumor Marker Levels Before and After Curative Treatment of Hepatocellular Carcinoma as Predictors of Patient Survival

Abstract

Abstract-fetoprotein (AFP) is used as a marker for hepatocellular carcinoma (HCC), which is influenced by hepatitis. Protein induced vitamin K absence or antagonist II (PIVKA-II) is a sensitive diagnostic marker. Changes in these markers after treatment may reflect curability and predict outcome. We conducted an analysis of prognosis in 470 HCC patients who received curative treatments, and examined relationship between changes in AFP and PIVKA-II levels after 1-month of treatment in 156 patients. Subjects were divided into three groups according to changes in both levels: 1) normal (L) group before treatment, 2) normalization (N) or 3) decreased but still above normal level or unchanged (ANU) group after treatment. High AFP and PIVKA-II levels were significantly associated with poor tumor-free and overall survival. Presence of large size and advanced stage were significantly associated with prevalence of DU group. Overall survival in the AFP-L group was significantly better than those of other groups and overall survival in PIVKA-II-L and N groups were significantly better than those of PIVKA-II-ANU groups. Combination of changes in AFP-ANU and PIVKA-II-ANU group showed the worst tumor-free and overall survivals. Multivariate analysis identified high pre-treatment levels of AFP and PIVKA-II and combination of AFP-ANU and PIVKA-II-ANU as significant determinants of poor tumor-free and overall survival, particularly in patients who underwent hepatectomy. We conclude that high levels of AFP or PIVKA-II after treatment for HCC did not sufficiently reflect curative efficacy of treatment and reflected a poor predictor of prognosis in HCC patients. Nanashima et al., Page 3

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

“…They are also useful as indicators of the therapeutic effect upon examination before and after tumor resection or local ablation therapy [17,18,19]. Two reports analyzed the relation between AFP and response and prognosis to sorafenib treatment.…”

“…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.…”

Relationship between Serum Hyaluronic Acid Level and Patient Prognosis in Hepatocellular Carcinoma Patients Who Underwent Hepatectomy

“…Monitoring sensitive markers such as these might be useful for predicting tumor recurrence after hepatectomy [25,26]. Our previous study showed that changes in PIVKA-II or AFP levels were significantly correlated with prognosis in HCC patients undergoing hepatectomy [11]. In addition to these conventional markers, new biomarkers of HCC have been proposed, [27,28] most of which are HCC specific.…”

“…Markers of poor hepatic function and tumor-related factors are significantly associated with tumor recurrence and lower survival [6][7][8]. Our previous study showed that an advanced grade of hepatic fibrosis, hepatitis, postoperative long-term ascites or postoperative levels of alpha-feto protein (a marker of chronic hepatitis) were significantly associated with shorter survival due to carcinoma after hepatectomy [9][10][11]. Deteriorated liver function and co-existing hepatitis would influence tumor progression and subsequent carcinogenesis.…”

Half-Life of Serum Alpha-Fetoprotein

“…[6][7][8] On the contrary, loss of serum AFP early after surgery has been found to predict delayed recurrence and increased survival. 9,10 Degradation of preformed serum AFP requires time, even after complete tumor excision. 11 Although the rate at which AFP changes ought be taken into consideration to establish any clinical correlation, this idea has not been tested extensively in HCC patients undergoing hepatectomy.…”