Early alpha-fetoprotein response can predict the prognosis of patients with intermediate-stage hepatocellular carcinoma treated with transarterial chemoembolization

Objectives To investigate the best definition of alpha-fetoprotein (AFP) response and its association with the outcome of patients with BCLC stage B hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE) . Methods A retrospective analysis was performed for the clinical data of 116 patients with intermediate-stage HCC who were treated with TACE in Department of Liver Disease and Digestive Interventional Radiology in Xijing Hospital of Digestive Disease from January 2010 to December 2014. The receiver operating characteristic curve was used to determine the optimal cut-off value of AFP change rate. The patients with a reduction in AFP greater than the cut-off value after surgery were defined as AFP response group (AFP-R group) , and the other patients were defined as AFP non-response group (AFP-NR group) . The Cox regression model was used for multivariate prognostic analyses. Results The median tumor size was 7. 5 cm, and of all patients, 112 (96. 6%) had Child-Pugh class A liver function. The optimal cut-off value was defined as a 16% reduction in AFP at 1 month after surgery, compared with baseline. The AFP-R group had a significantly longer median survival time than the AFP-NR group (26. 6 (20. 9-32. 3) months vs 7. 0 (5. 2-8. 8) months, HR = 3. 56, 95% CI: 2. 12-5. 95, P <0. 001) . The sub-group analysis showed that the AFP-NR group had significantly better prognosis than the AFP-NR group (P < 0. 05) .The multivariate analysis showed that age (HR = 0. 97, 95% CI: 0. 95-0. 99, P = 0. 003) , tumor size (HR = 1. 14, 95% CI: 1. 06-1. 22, P < 0. 001) , Eastern Cooperative Oncology Group performance score (HR = 2. 15, 95% CI: 1. 24-3. 73, P = 0. 006) , and AFP response (HR = 1. 56, 95% CI: 2. 12-5. 95, P < 0. 001) were independent risk factors for patients' survival. Conclusion Early AFP response can predict the prognosis of patients with intermediate-stage HCC treated with TACE.