连续甲胎蛋白水平在局部区域治疗肝细胞癌中的预后作用

StephenW

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

    Download citation https://doi.org/10.1080/00365521.2019.1660403 CrossMark Logo CrossMark

Abstract

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

StephenW

连续甲胎蛋白水平在局部区域治疗肝细胞癌中的预后作用
Shashi Bala Paul，Pabitra Sahu，Vishnubhatla Sreenivas，Neeti Nadda，Shivanand R. Gamanagatti，Baibaswata Nayak，显示全部
2019年6月14日收到，2019年8月20日接受，发布在线：2019年9月4日

下载引文https://doi.org/10.1080/00365521.2019.1660403 CrossMark Logo CrossMark

抽象

背景和目的：评估应答者和非应答者对局部区域治疗的早期连续AFP变化，并确定显着的AFP下降者和治疗后非下降者之间的差异。

方法：回顾性分析AFP≥20ng/ ml的肝细胞癌（HCC）患者的病例资料，并进行局部治疗。包括完整细节的患者。在多相MRI / CT肝脏评估的早期肿瘤反应（完全反应（CR），部分反应（PR），进展性疾病（PD））患者中连续AFP变化的趋势（从基线到治疗后一个月）治疗后一个月。绘制接收器操作曲线以估计最佳AFP减少截止值，以区分响应者（CR加PR）与非响应者（PD）。确定了AFP下降者（治疗后AFP水平降低超过20％的患者），并与AFP非下降者进行了临床参数，肿瘤反应和存活率的比较。

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。

结论：连续AFP改变可以预测肿瘤对AFP产生HCC患者局部治疗的反应。与AFP非下降者相比，AFP下降者的生存率和肿瘤反应更好。
关键词：肝细胞癌; ，甲胎蛋白; ，局部治疗; ，肿瘤反应; ，生存