Tumor Markers AFP, AFP-L3, and DCP in Hepatocellular Carcinoma Refractory to Transcatheter Arterial Chemoembolization

Abstract

Background/Aim: We examined tumor marker levels to assess in more detail transcatheter arterial chemoembolization (TACE)-refractory hepatocellular carcinoma (HCC). Materials and Methods: We enrolled patients treated from 2000 to 2011 for HCC beyond the Milan criteria who had good hepatic reserve function (Child-Pugh A) and no portal vein thrombosis or metastases (n = 154). The modified criteria for being TACE-refractory according to the Liver Cancer Study Group of Japan (m-LCSGJ), from which the tumor marker item was excluded, and the Assessment for Retreatment with TACE (ART) score were used for determining whether the HCC was TACE refractory. α-Fetoprotein ≥100 ng/ml, fucosylated α-fetoprotein ≥10%, and des-gamma-carboxy prothrombin ≥100 mAU/ml were used to define whether tumor markers were positive. We added up the number of positive tumor markers as a prognostic score to assess in more detail the evaluation of TACE-refractory HCC. Results: In order to divide the patients into a refractory and nonrefractory group, the m-LCSGJ criteria [mean survival time (MST) 27.1 vs. 49.9 months; p < 0.001] were superior to the ART score (MST 22.0 vs. 35.1 months; p = 0.051). In the refractory group according to the m-LCSGJ criteria, the patients with a low score of positive tumor markers (<2) after 2 sessions of TACE (n = 36) showed a better prognosis than the others (n = 72) (MST 37.7 vs. 23.2 months; p = 0.014). Conclusion: Patients being nonrefractory according to the m-LCSGJ criteria had a better response, and using the number of tumor markers (≥2) is an easy method for predicting the response to TACE and for a more detailed evaluation of TACE-refractory HCC.

Up‐to‐seven criteria as a useful predictor for tumor downstaging to within Milan criteria and Child–Pugh grade deterioration after initial conventional transarterial chemoembolization

“…Second, we also validated the widely reported fact that initial response is critical for patients who undergo TACE . In the present study, patients without recurrence within 1 year after the initial TACE showed the longest survival.…”

“…Second, we also validated the widely reported fact that initial response is critical for patients who undergo TACE. [18][19][20][21][22] In the present study, patients without recurrence within 1 year after the initial TACE showed the longest survival. Although tumor response to TACE is one of the most important factors that guides the next treatment decision, the rate of liver function deterioration is also important because some treatment options, such as resection and chemotherapy, are safe only when liver function is preserved.…”

Hepatic Function during Repeated TACE Procedures and Prognosis after Introducing Sorafenib in Patients with Unresectable Hepatocellular Carcinoma: Multicenter Analysis

“…If ALBI-grade is 2 at diagnosis of BCLC-B and unresectable HCC, then TACErefractory status should be assessed more strictly for avoiding a worsening hepatic function more with continuing TACE, so as to not lose the chance of switching to a molecular target drug. High levels of tumor markers [35] (positive for 2 of the following factors: alphafetoprotein >100 ng/mL, fucosylated alpha-fetoprotein >10%, des-gamma carboxyprothrombin >100 mAU/ mL) after 2 TACE procedures was reported to be poor as a prognostic marker in HCC patients with BCLC-B [36] , thus it is important to focus on malignant potential and maintain hepatic function other than response in such patients.…”

Proposed New Sub-Grouping for Intermediate-Stage Hepatocellular Carcinoma Using Albumin-Bilirubin Grade

“…Among intermediate-stage HCC patients treated with TACE, Takayasu et al [12] noted that the overall median period of survival was 3.3 years and that the 5-year survival rate was 34%. However, few systems for predicting the prognosis of patients with intermediate-stage HCC treated with TACE have been proposed [36,37,38]. In addition to the good capability for predicting prognosis and subsequent subdivision of all patients with intermediate-stage HCC, the present MICAN criteria might be also simple and useful for prediction of prognosis, specifically in those treated with TACE, and future additional studies for confirmation will be needed.…”