Prognostic role of serial alpha-fetoprotein levels in hepatocellular carcinoma treated with locoregional therapy
Shashi Bala Paul, Pabitra Sahu, Vishnubhatla Sreenivas, Neeti Nadda, Shivanand R. Gamanagatti, Baibaswata Nayak, show all
Received 14 Jun 2019, Accepted 20 Aug 2019, Published online: 04 Sep 2019
Background and aim: To evaluate early serial AFP changes in responders and non-responders to locoregional therapy and identify differences between significant AFP decliners and non-decliners post-treatment.
Methods: Case records of hepatocellular carcinoma (HCC) patients having AFP ≥20 ng/ml and treated with locoregional therapy were examined retrospectively. Patients with complete details were included. Trends of serial AFP change (from baseline to post-treatment one month) in patients showing early tumor response (complete response (CR), partial response (PR), progressive disease (PD)) as assessed on multiphasic MRI/CT liver performed at one month following treatment. Receiver operating curves were drawn to estimate the best AFP reduction cut off for differentiating between responders (CR plus PR) from non-responders (PD). AFP decliners (those with AFP level reduction greater than 20% post-treatment) were identified and comparisons of their clinical parameters, tumor response and survival rate were made with AFP non-decliners.
Results: HCC patients (n = 126) had mean age of 52.8 years, male:female ratio (4:1), Child’s A 94, BCLC stage A/B/C HCC 49/65/12, respectively. On 4–6 weeks’ MRI/CT, 46 patients developed CR, 55 PR and 25 PD. Reduction in median AFP level (83% in CR, 19% in PR) occurred in responders while 16% increase occurred in PD patients (non-responders). A 30% AFP reduction could differentiate responders from non-responders with 70% sensitivity and 68% specificity, AUROC 74% (CI 0.64–0.85). AFP decliners showed better survival and tumor response than non-decliners.
Conclusions: Serial AFP change can predict tumor response to locoregional therapy in AFP producing HCC patients. AFP decliners have better survival and tumor response than AFP non-decliners.
Keywords: Hepatocellular carcinoma; , alpha-fetoprotein; , locoregional therapy; , tumor response; , survival作者: StephenW 时间: 2019-9-6 21:22
结果：HCC患者（n = 126）的平均年龄为52.8岁，男性：女性比例（4：1），Child's A 94，BCLC分期A / B / C HCC 49/65/12。在4-6周的MRI / CT上，46名患者发生CR，55名PR和25名PD。中位AFP水平降低（CR为83％，PR为19％）在应答者中发生，而PD患者（无应答者）发生率增加16％。 30％AFP下降者表现出比非下降者更好的存活率和肿瘤反应。特异性为30％，AUROC为74％（CI 0.64-0.85）。与非衰退者相比，AFP下降者表现出更好的生存率和肿瘤反应。