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Alpha-fetoprotein assessment for hepatocellular carcinoma after transarterial chemoembolization

  • Interventional Radiology
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate whether AFP classification criteria correlate with tumor response measured using the European Association for the Study of the Liver (EASL) and predicate survival in patients with hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE).

Methods

Data from 143 consecutive patients with unresectable HCC and elevated AFP (> 20 ng/mL), who underwent TACE as initial treatment between January 2011 and December 2015 were collected, retrospectively. AFP response was classified as follows: complete response, normalization of AFP; partial response, > 50% decrease from baseline; stable disease, − 50 to + 30% change from baseline; or progressive disease, > 30% increase from baseline. Response rates according to AFP and EASL criteria were compared, and associations between the AFP response and overall survival (OS) were evaluated.

Results

The k value for agreement between AFP criteria and EASL criteria was 0.52 (moderate), with response rates of 42.7% and 41.3%, respectively (P = 0.811). The OS of responders was significantly longer compared with non-responders for both AFP (21 vs. 6 months, P < 0.001) and EASL (23 vs. 6 months, P < 0.001). Multivariate analysis revealed that the AFP response (hazard ratio [HR], 0.430, 95% CI, 0.233–0.794; P = 0.007), EASL response (HR, 0.343; 95% CI, 0.176–0.666; P = 0.002), and macroscopic vascular invasion (HR, 2.104; 95% CI, 1.403–3.154; P < 0.001) were significantly associated with OS.

Conclusions

The defined AFP classification criteria was moderate correlated with EASL criteria and predicted the outcome in patients with HCC who underwent TACE.

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References

  1. Jemal A, Siegel R, Ward E, et al. (2008) Cancer statistics, 2008. CA Cancer J Clin 58:71–96

    Article  PubMed  Google Scholar 

  2. Bruix J, Sherman M (2005) Management of hepatocellular carcinoma. Hepatology 42:1208–1236

    Article  PubMed  Google Scholar 

  3. European Association for the Study of The Liver (2012) European Organisation For Research and Treatment of Cancer EASL-EORTC clinical practice guidelines management of hepatocellular carcinoma. J Hepatol 56:908–943

    Article  Google Scholar 

  4. Forner A, Reig ME, de Lope CR, et al. (2010) Current strategy for staging and treatment: the BCLC update and future prospects. Semin Liver Dis 30:61–74

    Article  CAS  PubMed  Google Scholar 

  5. Lo CM, Ngan H, Tso WK, et al. (2002) Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 35:1164–1171

    Article  CAS  PubMed  Google Scholar 

  6. Omata M, Lesmana LA, Tateishi R, et al. (2010) Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma. Hepatol Int 4:439–474

    Article  PubMed  PubMed Central  Google Scholar 

  7. Llovet JM, Bruix J (2003) Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology 37:429–442

    Article  CAS  PubMed  Google Scholar 

  8. Miller AB, Hoogstraten B, Staquet M, et al. (1998) Reporting results of cancer treatment. Cancer 47:207–214

    Article  Google Scholar 

  9. Therasse P, Arbuck SG, Eisenhauer EA, et al. (2000) New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 92:205–216

    Article  CAS  Google Scholar 

  10. Bruix J, Sherman M, Llovet JM, et al. (2001) Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 35:421–430

    Article  CAS  PubMed  Google Scholar 

  11. Lencioni R, Llovet JM (2010) Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 30:52–60

    Article  CAS  Google Scholar 

  12. Jung ES, Kim HJ, Yoon EL, et al. (2013) Comparison of the methods for tumor response assessment in patients with hepatocellular carcinoma undergoing transarterial chemoembolization. J Hepatol 58:1181–1187

    Article  PubMed  Google Scholar 

  13. Gillmore R, Stuart S, Kirkwood A, et al. (2011) EASL and mRECIST response are independent prognostic factors for survival in hepatocellular cancer patients treated with transarterial chemoembolization. J Hepatol 55:1309–1316

    Article  PubMed  Google Scholar 

  14. Shim JH, Lee HC, Kim SO, et al. (2012) Which response criteria best help predict survival of patients with hepatocellular carcinoma following chemoembolization? A validation study of old and new models. Radiology 262:708–718

    Article  PubMed  Google Scholar 

  15. Mclntire KR, Vogel CL, Princler GL, et al. (1972) Serum alpha-fetoprotein as a biochemical marker for hepatocellular carcinoma. Cancer Res 32:1941–1946

    Google Scholar 

  16. Tangkijvanich P, Anukulkarnkusol N, Suwangool P, et al. (2000) Clinical characteristics and prognosis of hepatocellular carcinoma: analysis based on serum alpha-fetoprotein levels. J Clin Gastroenterol 31:302–308

    Article  CAS  PubMed  Google Scholar 

  17. Baig JA, Alam JM, Mahmood SR, et al. (2009) Hepatocellular carcinoma (HCC) and diagnostic significance of alpha-fetoprotein (AFP). J Ayub Med Coll Abbottabad 21:72–75

    PubMed  Google Scholar 

  18. Zhang YQ, Jiang LJ, Jia Wen, et al. (2018) Comparison of alpha-fetoprotein criteria and mRECIST for the prediction of overall survival of hepatocellular carcinoma patients after transarterial chemoembolization. J Vasc Interv Radiol 29:1654–1661

    Article  PubMed  Google Scholar 

  19. Chan SL, Mo FK, Johnson PJ, et al. (2009) New utility of an old marker: serial alpha-fetoprotein measurement in prediting radiologic response and survival of patients with hepatocellular carcinoma undergoing systemic chemotherapy. J Clin Oncol 27:446–452

    Article  CAS  PubMed  Google Scholar 

  20. Personeni N, Bozzarelli S, Pressiani T, et al. (2012) Usefulness of alpha-fetoprotein response in patients treated with sorafenib for advanced hepatocellular carcinoma. J Hepatol 57:101–107

    Article  CAS  PubMed  Google Scholar 

  21. Yau T, Yao TJ, Chan P, et al. (2011) The significance of early Alpha-fetoprotein level changes in predicting clinical and survival benefits in advanced hepatocellular carcinoma patients receiving sorafenib. Oncologist 16:1270–1279

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Shao YY, Lin ZZ, Hsu C, et al. (2010) Early alpha-fetoprotein response predicts treatment efficacy of antiangiogenic systemic therapy in patients with advanced hepatocellular carcinoma. Cancer 116:4590–4596

    Article  CAS  PubMed  Google Scholar 

  23. Liu L, Zhao Y, Jia J, et al. (2016) The prognostic value of alpha-fetoprotein response for advanced-stage hepatocellular carcinoma treated with Sorafenib combined with transarterial chemoembolization. Sci Rep 6:19851

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Memon K, Kulik L, Lewandowski RJ, et al. (2012) Alpha-fetoprotein response correlates with EASL response and survival in solitary hepatocellular carcinoma treated with transarterial therapies: a subgroup analysis. J Hepatol 56:1113–1120

    Article  CAS  Google Scholar 

  25. Riaz A, Ryu RK, Kulik LM, et al. (2009) Alpha-fetoprotein response after locoregional therapy for hepatocellular carcinoma: oncologic marker of radiologic response, progression, and survival. J Clin Oncol 27:5734–5742

    Article  CAS  PubMed  Google Scholar 

  26. Kadalayil L, Benini R, Pallan L, et al. (2013) A simple prognostic scoring system for patients receiving transarterial embolisation for hepatocellular cancer. Ann Oncol 24:2565–2570

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Pinato DJ, Arizumi T, Allara E, et al. (2015) Validation of the hepatoma arterial embolization prognostic score in European and Asian populations and proposed modification. Clin Gastroenterol Hepatol 13:1204–1208

    Article  PubMed  Google Scholar 

  28. Park Y, Kim SU, Kim BK, et al. (2016) Addition of tumor multiplicity improves the prognostic performance of the hepatoma arterial-embolization prognostic score. Liver Int 36:100–107

    Article  CAS  PubMed  Google Scholar 

  29. Xu L, Peng ZW, Chen MS, et al. (2015) Prognostic nomogram for patients with unresectable hepatocellular carcinoma after transcatheter arterial chemoembolization. J Hepatol 63:122–130

    Article  PubMed  Google Scholar 

  30. Zhang Y, Fan W, Wang Y, et al. (2015) Sorafenib with and without transarterial chemoembolization for advanced hepatocellular carcinoma with main portal vein tumor thrombosis: a retrospective analysis. Oncologist 20:1417–1424

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Kim BK, Kim SU, Kim KA, et al. (2015) Complete response at first chemoembolization is still the most robust predictor for favourable outcome in hepatocellular carcinoma. J Heaptol 62:1304–1310

    Article  Google Scholar 

  32. Wang W, Zhao Y, Bai W, et al. (2015) Response assessment for HCC patients treated with repeated TACE: The optimal time-point is still an open issue. J Hepatol 63:1530–1531

    Article  PubMed  Google Scholar 

  33. Viera AJ, Garrett JM (2005) Understanding interobserver agreement: the kappa statistic. Fam Med 37:360–363

    PubMed  Google Scholar 

  34. Shim JH, Park JW, Kim JH, et al. (2008) Association between increment of serum VEGF level and prognosis after transcatheter arterial chemoembolization in hepatocellular carcinoma patients. Cancer Sci 99:2037–2044

    CAS  PubMed  Google Scholar 

  35. Kim HD, Lim YS, Han S, et al. (2015) Evaluation of early-stage hepatocellular carcinoma by magnetic resonance imaging with gadoxetic acid detects additional lesions and increases overall survival. Gastroenterology 148:1371–1382

    Article  CAS  PubMed  Google Scholar 

  36. Ozkavukcu E, Haliloglu N, Erden A (2009) Post-treatment MRI findings of hepatocellular carcinoma. Diagnostic and interventional radiology 15:111–120

    PubMed  Google Scholar 

  37. Pote N, Cauchy F, Albuquerque M, et al. (2015) Performance of PIVKA-II for early hepatocellular carcinoma diagnosis and prediction of microvascular invasion. J Hepatol 62:848–854

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Yingqiang Zhang.

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Tian, M., Zhang, X., Huang, G. et al. Alpha-fetoprotein assessment for hepatocellular carcinoma after transarterial chemoembolization. Abdom Radiol 44, 3304–3311 (2019). https://doi.org/10.1007/s00261-019-02116-x

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  • DOI: https://doi.org/10.1007/s00261-019-02116-x

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