Alpha-fetoprotein response correlates with EASL response and survival in solitary hepatocellular carcinoma treated with transarterial therapies: A subgroup analysis

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• 作者：Khairuddin Memon¹ ; Laura Kulik² ; Robert J. Lewandowski¹ ; Edward Wang³ ; Robert K. Ryu¹ ; Ahsun Riaz¹ ; Paul Nikolaidis¹ ; Frank H. Miller¹ ; Vahid Yaghmai¹ ; Talia Baker³ ; Michael Abecassis³ ; Al B. Benson 3rd⁴ ; Mary F. Mulcahy⁴ ; Reed A. Omary¹ ; Riad Salem¹ ; ³ ; ⁴ ; ^{r-salem@northwestern.edu}
• 关键词：HCC ; hepatocellular carcinoma ; LRT ; locoregional therapy ; CT ; triphasic contrast-enhanced computerized tomography ; MRI ; magnetic resonance imaging ; AFP ; alpha-fetoprotein ; WHO ; World Health Organization ; EASL ; European Association for the Study of the Liv
• 刊名：Journal of Hepatology
• 出版年：2012
• 期刊代码：162_01688278
• 类别：med
• 出版时间：May, 2012
• 卷：56
• 期：5
• 页码：1112-1120
• 文件大小：981 K

摘要

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Background & Aims

Alpha-fetoprotein (AFP) is a universally recognized tumor marker in hepatocellular carcinoma (HCC). Its utility in assessing response to treatment remains controversial. We sought to study the: (a) correlation between AFP response and imaging response, and (b) ability of AFP, EASL, and WHO response to predict survival outcomes in patients with solitary HCC.

Methods

Six hundred and twenty-nine HCC patients were treated with transarterial locoregional therapies over an 11-year period. To eliminate confounding factors, we included patients with single tumors, baseline AFP 猢?00 ng/ml, and no extrahepatic disease; this identified our study cohort of 51 patients. AFP response was defined as >50%decrease from baseline; this was correlated to EASL and WHO response criteria by Kappa agreement, Pearson correlation and receiver operating curves. Survival analyses were performed by Landmark, risk-of-death and Mantel-Byar methodologies. None of the patients received sorafenib.

Results

Three months post-treatment, AFP and EASL response correlated well (Kappa: 0.83; Pearson: 0.84); the sensitivity, specificity, positive and negative predictive values of AFP in predicting EASL response at 3 months were 96.6%, 85.7%, 92.3%, and 93.3%, respectively. Correlation with WHO response was low. From the 3-month landmark, WHO, EASL, and AFP responders survived longer than non-responders (p = 0.006, 0.0001, and <0.0001, respectively). The risk of death was lower for EASL and AFP responders by both risk-of-death and Mantel-Byar methodologies (p <0.05).

Conclusions

Response by AFP and EASL are predictors of survival outcome in patients with solitary HCC. AFP correlates with imaging response assessment by EASL guidelines. Achieving AFP response should be one of the therapeutic intents of locoregional therapies (LRTs).