Prognostic value of alpha-fetoprotein and des-gamma-carboxy prothrombin responses in patients with hepatocellular carcinoma treated with transarterial chemoembolization
Menée sur 115 patients atteints d'un carcinome hépatocellulaire traité par chimio-embolisation transartérielle (âge médian : 59 ans ; 81 hommes et 34 femmes), cette étude évalue, du point de vue de la survie sans progression et de la survie globale, la valeur pronostique de la réponse thérapeutique à l'alpha-fœtoprotéine et à la décarboxyprothrombine
Background/Aims: Alpha-fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP) have been used as diagnostic tools for hepatocellular carcinoma (HCC). However, prediction of outcome using AFP and DCP has not been elucidated. We investigated the clinical role of AFP and DCP as predictors of treatment outcome in patients with HCC undergoing trans-arterial chemoembolization (TACE).METHODS:Between January 2003 and December 2005, we enrolled 115 treatment-naive patients who received TACE as an initial treatment modality. An AFP or DCP response was defined as a reduction of more than 50% from the baseline level 1 month after TACE. Patients with AFP < 20 ng/mL or DCP < 20 mAU/mL were excluded.RESULTS:The median age was 59 years and the male gender predominated (n = 81, 70.4%). AFP and DCP response was identified in 91 (79.1%) and 77 (66.9%) patients after TACE. Although progression-free survival (PFS) did not differ according to AFP response (P = 0.150), AFP responders showed significantly better overall survival (OS) than non-responders (34.9 vs. 13.2 months; P = 0.002). In contrast, DCP response did not influence either PFS or OS (all P > 0.05). Multivariate analyses showed that gamma-glutamyltranspeptidase and baseline AFP were predictors of PFS (all P < 0.05) and that male gender, the presence of liver cirrhosis, baseline DCP, number of measurable tumors and AFP response were independent predictors of OS (all P < 0.05).CONCLUSIONS:AFP response and higher baseline DCP level are significant predictors of OS in treatment-naive patients with HCC receiving TACE who showed pretreatment elevation of both AFP and DCP.
BMC Cancer , article en libre accès, 2012