Abstract:
Objective To evaluate the clinical value of alpha-fetoprotein (AFP) response in patients with advanced hepatocellular carcinoma with portal vein tumor thrombosis receiving transarterial chemoembolization (TACE) treatment.
Methods A total of 110 advanced hepatocellular carcinoma patients with portal vein tumor thrombosis, with baseline AFP levels above 200 ≥ ng/mL and undergoing TACE therapy at the Sun Yat-Sen University Cancer Center between June 2007 and December 2008, were included in this study. AFP was collected in conjunction with radiologic outcomes after four to six weeks of treatment for transarterial chemoembolization. AFP response (AFP R) was defined as more than 20 % decrease from baseline after four weeks to six weeks of TACE treatment. Any case which did not qualify for AFP-R was defined as AFP non-response (AFP NR). Radiographic response was assessed by modified Response Evaluation Criteria in Solid Tumors (mRECIST).
Results The characteristics of the 110 patients were as follows: the median age of the patients was 44 years old; hepatitis B surface antigen (HBsAg) was positive in 105 of the patients (95.5 %); and the median base level of AFP was 21 700 ng/mL. A total of 57 cases (51.8 %) were focal hepatocellular carcinoma (F HCC), whereas the other 53 cases (48.2 %) were diffused hepatocellular carcinoma (D HCC). A total of 48 cases (43.6 %) were infringed upon the portal vein. AFP-R was found in 37 of the patients (33.6 %) and AFP-NR was found in 73 patients (66.4 %). According to the mRECIST criterion, clinical benefit (CB) was seen in 33 cases (89.2 %) with AFP-R and 16 (21.9 %) with AFP-NR, respectively. AFP-R had a positive correlation with radiologic response (P < 0.001, r = 0.677). The 6-, 12-, 24-, and 36-month overall survival rates were 76 %, 35 %, 11%, and 5 %, respectively, for the AFP responders and 21%, 8 %, 4 %, and 2 %, respectively, for the AFP non-responders. Median overall survival time (7.9 months vs. 4.1 months; P < 0.001) was longer in the AFP-R patients than in the AFP-NR patients. Multivariate analysis suggested that F-HCC (P = 0.041) and AFP response (P = 0.004) were signiicantly associated with survival.
Conclusion Early AFP-R may be useful in predicting radiologic response and clinically beneficial for the survival rate of hepatocellular carcinoma patients with portal vein tumor thrombosis undergoing transarterial chemoembolization.