Yonsei Med J.  2021 Jan;62(1):12-20. 10.3349/ymj.2021.62.1.12.

Prognostic Value of Alpha-Fetoprotein in Patients Who Achieve a Complete Response to Transarterial Chemoembolization for Hepatocellular Carcinoma

Affiliations
  • 1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
  • 2Yonsei Liver Center, Severance Hospital, Seoul, Korea
  • 3Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
  • 4Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 5Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
  • 6Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
  • 7Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
  • 8Liver Center, Pusan National University Yangsan Hospital, Yangsan, Korea
  • 9Department of Internal Medicine, Yeungnam University Medical Centre, Daegu, Korea
  • 10Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea

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.

Keyword

Carcinoma; hepatocellular; alpha-fetoprotein; prognosis; treatment outcome; transarterial chemoembolization
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