Prognostic Value of Alpha-Fetoprotein in Patients Who Achieve a Complete Response to Transarterial Chemoembolization for Hepatocellular Carcinoma
- Author:
Jae Seung LEE
1
;
Young Eun CHON
;
Beom Kyung KIM
;
Jun Yong PARK
;
Do Young KIM
;
Sang Hoon AHN
;
Kwang-Hyub HAN
;
Wonseok KANG
;
Moon Seok CHOI
;
Geum-Youn GWAK
;
Yong-Han PAIK
;
Joon Hyeok LEE
;
Kwang Cheol KOH
;
Seung Woon PAIK
;
Hwi Young KIM
;
Tae Hun KIM
;
Kwon YOO
;
Yeonjung HA
;
Mi Na KIM
;
Joo Ho LEE
;
Seong Gyu HWANG
;
Soon Sun KIM
;
Hyo Jung CHO
;
Jae Youn CHEONG
;
Sung Won CHO
;
Seung Ha PARK
;
Nae-Yun HEO
;
Young Mi HONG
;
Ki Tae YOON
;
Mong CHO
;
Jung Gil PARK
;
Min Kyu KANG
;
Soo Young PARK
;
Young Oh KWEON
;
Won Young TAK
;
Se Young JANG
;
Dong Hyun SINN
;
Seung Up KIM
;
Author Information
- Publication Type:Original Article
- From:Yonsei Medical Journal 2021;62(1):12-20
- CountryRepublic of Korea
- Language:English
-
Abstract:
Purpose:Alpha-fetoprotein (AFP) is a prognostic marker for hepatocellular carcinoma (HCC). We investigated the prognostic value of AFP levels in patients who achieved complete response (CR) to transarterial chemoembolization (TACE) for HCC.
Materials and Methods:Between 2005 and 2018, 890 patients with HCC who achieved a CR to TACE were recruited. An AFP responder was defined as a patient who showed elevated levels of AFP (>10 ng/mL) during TACE, but showed normalization or a >50% reduction in AFP levels after achieving a CR.
Results:Among the recruited patients, 569 (63.9%) with naïve HCC and 321 (36.1%) with recurrent HCC after complete resection were treated. Before TACE, 305 (34.3%) patients had multiple tumors, 219 (24.6%) had a maximal tumor size >3 cm, and 22 (2.5%) had portal vein tumor thrombosis. The median AFP level after achieving a CR was 6.36 ng/mL. After a CR, 473 (53.1%) patients experienced recurrence, and 417 (46.9%) died [median progression-free survival (PFS) and overall survival (OS) of 16.3 and 62.8 months, respectively]. High AFP levels at CR (>20 ng/mL) were independently associated with a shorter PFS [hazard ratio (HR)=1.403] and OS (HR=1.284), together with tumor multiplicity at TACE (HR=1.518 and 1.666, respectively). AFP non-responders at CR (76.2%, n=359 of 471) showed a shorter PFS (median 10.5 months vs. 15.5 months, HR=1.375) and OS (median 41.4 months vs. 61.8 months, HR=1.424) than AFP responders (all p=0.001).
Conclusion:High AFP levels and AFP non-responders were independently associated with poor outcomes after TACE. AFP holds clinical implications for detailed risk stratification upon achieving a CR after TACE.
