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.
journal_name
Yonsei Med Jjournal_title
Yonsei medical journalauthors
Lee JS,Chon YE,Kim BK,Park JY,Kim DY,Ahn SH,Han KH,Kang W,Choi MS,Gwak GY,Paik YH,Lee JH,Koh KC,Paik SW,Kim HY,Kim TH,Yoo K,Ha Y,Kim MN,Lee JH,Hwang SG,Kim SS,Cho HJ,Cheong JY,Cho SW,Park SH,Heo NY,Hdoi
10.3349/ymj.2021.62.1.12subject
Has Abstractpub_date
2021-01-01 00:00:00pages
12-20issue
1eissn
0513-5796issn
1976-2437pii
62.12journal_volume
62pub_type
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