Prognostic value of pretreatment levels of tumor markers for hepatocellular carcinoma on survival after curative treatment of patients with HCC (original) (raw)
Related papers
World Journal of Gastroenterology
To explore the potential prognostic role of preoperative tumor grade and blood AFP mRNA in a cohort of patients with hepatocellular carcinoma (HCC) eligible for radical therapies according to a well-defined treatment algorithm not including nodule size and number as absolute selection criteria. Fifty patients with a diagnosis of HCC were prospectively enrolled in the study. Inclusion criteria were: (1) histological assessment of tumor grade by means of percutaneous biopsies; (2) determination of AFP mRNA status in the blood; (3) patient's eligibility for radical therapies. At preoperative evaluation, 54% of the study group had a well-differentiated HCC, 42% had AFP mRNA in the blood, 40% had a tumor larger than 5 cm and 56% had more than one nodule. Surgery (resection or liver transplantation) was performed in 29 patients, while 21 had percutaneous ablation procedures. After a median follow-up of 28 mo, 12-, 24-, and 36-mo survival rates were 78%, 58%, and 51%, respectively. Sur...
Oncology Reports, 2004
The prognostic impact of serum a-fetoprotein (AFP) level in patients with hepatocellular carcinoma (HCC) is controversial. This study aimed to investigate the predictive ability of serum AFP in HCC patients. A total of 543 patients undergoing surgical resection (258 patients) and non-surgical treatment (285 patients) including transarterial chemoembolization and percutaneous injection therapy were retrospectively studied. Overall, AFP level >400 ng/ml was an independent poor prognostic predictor [relative risk (RR): 1.4, 95% confidence interval (CI): 1.0-1.9, p=0.049]. Stratified analysis showed that there was a sharp contrast of predictive power of AFP level in treatment strategy and tumor size. In surgical patients, serum AFP >400 ng/ml was a tumor size-independent predictor of tumor recurrence (RR: 1.7, 95% CI: 1.2-2.5, p=0.006) and survival (RR: 2.3, 95% CI: 1.3-3.8, p=0.002). However, there was no association between AFP level and survival in the nonsurgical group (p=0.597). Alternatively, among the 157 patients with large (>5 cm) HCCs, AFP >400 ng/ml independently predicted a poor survival (RR: 1.9, 95% CI: 1.2-2.5, p=0.012), whereas no clear relationship between AFP level and survival was found among the 386 patients with small (<5 cm) HCCs (p=0.685). There was no differential prognostic impact of serum AFP levels in other variables. In conclusion, serum AFP level is a weak prognostic predictor in HCC patients. Its predictive ability is highly selective and dependent on treatment strategy and tumor size. Incorporation of serum AFP level into any prognostic prediction model should be based on its distinctive selective prognostic power.
Afro-Egyptian Journal of Infectious and Endemic Diseases, 2018
Background and study aim: Prognostic value of serum alpha-fetoprotein (AFP) in hepatocellular carcinoma (HCC) is still debatable. We aimed to study this role in HCC patients who underwent radiofrequency ablation (RFA). Materials and Methods: Records from HCC patients were retrospectively analyzed between January 2012 and December 2016. A minimum data set for each patient record of a follow-up period of at least 1 year was pre-defined before enrollment. In all, 153 patients were enrolled. AFP levels were recorded for all patients at the time of diagnosis, 1 month after RFA and at 3-month intervals afterward. Patients were divided according to pretreatment AFP level into 3 groups: group 1: AFP <20 ng/mL, group 2: AFP 20-200 ng/mL and group 3: AFP >200 ng/mL. Results: Pretreatment AFP is not significantly correlated with age, baseline lesion number or size, baseline Child score or class, post RFA recurrence or death. The overall survival rates were 95%, 75.6%, 55.6%, 48.8%, and 48.8% at 1,2,3,4, and 5 years respectively. On comparing the 3 groups on disease-free survival, there was no statistically significant difference among the three classes. Child class A patients showed statistically significant better survival after RFA than those with Child class B. The ROC curve showed that AFP had inadequate accuracy to discriminate survivors and deceased patients and to discriminate patients with recurrence from those without recurrence. Conclusion: AFP level could not be used as a good predictor of either death or recurrence of HCC after RFA
United European Gastroenterology Journal
Background: Hepatocellular carcinoma is one of the most lethal cancers worldwide. Novel prognostic and/or predictive biomarkers are urgently needed to improve patient management. Alpha-fetoprotein (AFP) is a well-established and widely used biomarker for hepatocellular carcinoma. However, diagnostic accuracy of static AFP values is limited and the clinical potential is a matter of ongoing scientific discussion. Objective: We here evaluated the prognostic impact of pretreatment static and dynamic AFP variables on overall survival of hepatocellular carcinoma patients in a Western cohort. Methods: Patients with confirmed hepatocellular carcinoma (n = 809) treated at the Johannes Gutenberg University Mainz between 1998 and 2014 and two available pretreatment AFP-values (AFP-slope) were retrospectively analysed. Clinicopathological baseline parameters, pretreatment static values and AFP-slope were assessed. Prognostic impact was determined by Kaplan-Meier analyses and Cox regression models. Results: High static and dynamic AFP variables prior to therapy were associated with reduced survival rates of hepatocellular carcinoma patients. Several known clinical parameters such as Child-Pugh B (p < 0.01) and C stage (p < 0.001), portal vein thrombosis (p < 0.001) and extrahepatic spread (p < 0.001) were confirmed as independent predictors for overall survival. Addition of static and/or dynamic AFP variable resulted in higher time-dependent area under the curves. Notably, in patients with more favourable prognosis, AFP-slope prior to therapy was a slightly stronger predictor for overall survival compared with static AFP values. Conclusion: Static and dynamic AFP variables prior to therapy are predictive for overall survival of hepatocellular carcinoma patients. Addition of AFP-slope to established prognostic parameters might improve prognostic classification for a This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Journal of Medical Microbiology & Diagnosis, 2014
Background and aims: Early detection of Hepatocellular Carcinoma (HCC) is crucial for effective management. Incidence of HCC has increased in the United States largely attributed to hepatitis B and C virus. Lens culinaris agglutinin-reactive Alpha-Fetoprotein (AFP-L3) and Des-Gamma-Carboxy Prothrombin (DCP) are being recognized specific biomarkers for HCC. Methods: We measured AFP-L3 and DCP in serial serum specimens of a cohort of chronic hepatitis patients on HCC surveillance and compared these markers to abdominal imaging. Among fifty patients who developed HCC during surveillance, 30 were included in the study with available sera 1-2 years before, at diagnosis and post ablation of HCC. For controls, three consecutive annual sera were examined from 106 chronic hepatitis patients without HCC during surveillance for 5-10 years. The µTASWako i30 auto analyzer was used for the assay that utilizes the microfluidics chip based assay platform. It can fractionate AFP-L3 glycoform and calculates AFP-L3% if AFP level is ≥ 0.6 ng/mL. Results: Combination of AFP, AFP-L3 and DCP showed high sensitivity of 83% in all patients and 75% in patients with AFP<20 ng/mL. AFP-L3 and DCP assays were useful in patients with low levels of AFP (<20 ng/mL) and could detect significant AFP-L3% elevation in some patients more than one year before the diagnosis of HCC. Furthermore, AFP-L3 predicted recurrence of HCC. Conclusions: This is the first study in the U.S. patients using the µTASWako i30 analyzer to test these HCC biomarkers. Our results suggest that combinations of these biomarkers are highly useful for early detection of HCC.
The Egyptian Journal of Hospital Medicine, 2018
Background: incidence of hepatocellular carcinoma (HCC) has rapidly increased worldwide. HCC is the sixth most common malignancy and the third most common cause of cancer related death. Since HCC usually develops in a damaged liver, the prognosis of HCC depends not only on tumor progression but also on the degree of liver dysfunction. In Egypt, HCC constitutes 70.48% of all liver tumors among Egyptians. Aim of the Work: to validate the use of AFP model as a predictor of response, recurrence and survival in hepatocellular carcinoma patients after locoregional treatment. Patients and Methods: this study was conducted at Tropical Medicine department and HCC clinic, Ain Shams University Hospitals. The study was approved by the Research and Ethics Committee of Ain Shams University, Cairo, Egypt in accordance with local research governance requirements. Results: according to this classification 130 patients are for RFA and 70 patients are for TACE but actually 132 patients underwent TACE ...
Hepatology Research, 2007
The efficacies of tumor markers, alfa-fetoprotein (AFP), Lens culinaris agglutinin A-reactive fraction of alfa-fetoprotein (AFP-L3), and des-gamma-carboxy prothrombin (DCP) were evaluated for assessment of progression of hepatocellular carcinoma (HCC) and patient prognosis. The prevalence of elevated levels of each tumor marker increased with progression of tumor stage for all three markers among patients with HCC. Survival was poorer among patients with elevated levels of tumor markers than among those without elevated levels.
Hepatology, 2006
Three tumor markers for hepatocellular carcinoma (HCC) are available in daily practice in Japan: alpha-fetoprotein (AFP), des-gamma-carboxy prothrombin (DCP), and lens culinaris agglutinin-reactive fraction of alpha-fetoprotein (AFP-L3). To elucidate the predictability of these tumor markers on HCC recurrence after curative ablation, we enrolled 416 consecutive patients with naïve HCC who had been treated by percutaneous ablation at our department from July 1997 to December 2002. Tumor marker levels were determined immediately before and 2 months after the treatment. Complete ablation was defined on CT findings as nonenhancement in the entire lesion with a safety margin. Tumor recurrence was also defined as newly developed lesions on CT that showed hyperattenuation in the arterial phase with washout in the late phase. We assessed the predictability of recurrence via tumor markers in multivariate analysis, using proportional hazard regression after adjusting for other significant factors in univariate analysis. Until the end of follow-up, tumor recurrence was identified in 277 patients. Univariate analysis revealed the following factors to be significant for recurrence: platelet count; size and number of tumors; AFP, AFP-L3, and DCP preablation; and AFP and AFP-L3 postablation. Multivariate analysis indicated that AFP >100 ng/mL and AFP-L3 >15%, both pre- and postablation, were significant predictors. The positivity of AFP and AFP-L3 preablation that turned negative postablation was not significant. In conclusion, tumor markers pre- and post-ablation were significant predictors for HCC recurrence and can complement imaging modalities in the evaluation of treatment efficacy. (HEPATOLOGY 2006;44:1518–1527.)
Egyptian Liver Journal, 2013
The aim of this study was to evaluate the role of the protein induced by the absence of vitamin K or antagonist II (PIVKA-II) and the lens culinaris fraction of a-fetoprotein (AFP-L3%) in the diagnosis of patients with hepatocellular carcinoma having normal and abnormal AFP levels. Patients and methods This study was carried out on 441 individuals attending the National Liver Institute Hospital. Venous blood samples (10 ml) were drawn from all included patients and tested for liver function, viral markers (HBsAg, HCV Abs), antibilharzial antibodies, AFP, AFP-L3%, and PIVKA-II. Results Accuracy of AFP increased from 60.2 to 87.7% when levels of AFP-L3% and PIVKA-II were taken into consideration in the diagnosis of hepatocellular carcinoma (HCC) in patients with AFP levels less than 400 ng/dl, whereas it decreased from 100.0 to 82.5% when these levels were considered in the diagnosis of patients with AFP levels of 400 ng/dl or higher. Conclusion From the above findings, we conclude that in the HCC group with abnormal AFP levels (Z400 ng/ml), the serum AFP level remains the most useful tumor marker in diagnosis. The mean values of AFP-L3% appear to be more specific than mean AFP values in the diagnosis of HCC group with normal AFP levels (o400 ng/ml) as it is less often elevated in patients having cirrhosis without HCC, which does not hold true for AFP or PIVKA-II, and this implies that AFP-L3% is closely associated with the presence of HCC.