Alpha-fetoprotein response after locoregional therapy for hepatocellular carcinoma: Oncologic marker of radiologic response, progression, and survival

Ahsun Riaz, Robert K. Ryu, Laura M. Kulik, Mary F. Mulcahy, Robert J. Lewandowski, Jeet Minocha, Saad M. Ibrahim, Kent T. Sato, Talia Baker, Frank H. Miller, Steven Newman, Reed Omary, Michael Abecassis, Al B. Benson, Riad Salem*

*Corresponding author for this work

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141 Citations (Scopus)

Abstract

Purpose: Alpha-fetoprotein (AFP) is considered to be an indicator of tumor activity in hepatocellular carcinoma (HCC). We present a novel correlation of AFP response to radiologic response, time-to-progression (TTP), progression-free survival (PFS), and overall survival (OS) in patients treated with locoregional therapies. Patients and Methods: Four hundred sixty-three patients with HCC were treated with chemoembolization or radioembolization at our institution. One hundred twenty-five patients with baseline AFP higher than 200 ng/mL were studied for this analysis. AFP response was defined as more than 50% decrease from baseline. One hundred nineteen patients with follow-up imaging were studied for the AFP imaging correlation analysis. AFP response was correlated to radiologic response, TTP, PFS, and OS. Multivariate analyses were performed. Results: Eighty-one patients (65%) showed AFP response. AFP response was seen in 26 (55%) of 47 and 55 (70%) of 78 of patients treated with chemoembolization and radioembolization, respectively (P = .12). WHO response was seen in 41 (53%) of 77 and 10 (24%) of 42 of AFP responders and nonresponders, respectively (P = .002). The hazard ratio (HR) for TTP in AFP nonresponders compared with responders was 2.8 (95% CI, 1.5 to 5.1). The HR for PFS was 4.2 (95% CI, 2.4 to 7.2) in AFP nonresponders compared with responders. The HR for OS in AFP nonresponders compared with responders was 5.5 (95% CI, 3.1 to 9.9) and 2.7 (95% CI, 1.6 to 4.6) on univariate and multivariate analyses, respectively. Conclusion: The data presented support the use of AFP response seen after locoregional therapy as an ancillary method of assessing tumor response and survival, as well as an early objective screening tool for progression by imaging.

Original languageEnglish (US)
Pages (from-to)5734-5742
Number of pages9
JournalJournal of Clinical Oncology
Volume27
Issue number34
DOIs
StatePublished - Dec 1 2009

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alpha-Fetoproteins
Hepatocellular Carcinoma
Survival
Therapeutics
Disease-Free Survival
Reaction Time
Multivariate Analysis
Neoplasms

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

@article{e03c05a40c844d899458fa16eae32bf9,
title = "Alpha-fetoprotein response after locoregional therapy for hepatocellular carcinoma: Oncologic marker of radiologic response, progression, and survival",
abstract = "Purpose: Alpha-fetoprotein (AFP) is considered to be an indicator of tumor activity in hepatocellular carcinoma (HCC). We present a novel correlation of AFP response to radiologic response, time-to-progression (TTP), progression-free survival (PFS), and overall survival (OS) in patients treated with locoregional therapies. Patients and Methods: Four hundred sixty-three patients with HCC were treated with chemoembolization or radioembolization at our institution. One hundred twenty-five patients with baseline AFP higher than 200 ng/mL were studied for this analysis. AFP response was defined as more than 50{\%} decrease from baseline. One hundred nineteen patients with follow-up imaging were studied for the AFP imaging correlation analysis. AFP response was correlated to radiologic response, TTP, PFS, and OS. Multivariate analyses were performed. Results: Eighty-one patients (65{\%}) showed AFP response. AFP response was seen in 26 (55{\%}) of 47 and 55 (70{\%}) of 78 of patients treated with chemoembolization and radioembolization, respectively (P = .12). WHO response was seen in 41 (53{\%}) of 77 and 10 (24{\%}) of 42 of AFP responders and nonresponders, respectively (P = .002). The hazard ratio (HR) for TTP in AFP nonresponders compared with responders was 2.8 (95{\%} CI, 1.5 to 5.1). The HR for PFS was 4.2 (95{\%} CI, 2.4 to 7.2) in AFP nonresponders compared with responders. The HR for OS in AFP nonresponders compared with responders was 5.5 (95{\%} CI, 3.1 to 9.9) and 2.7 (95{\%} CI, 1.6 to 4.6) on univariate and multivariate analyses, respectively. Conclusion: The data presented support the use of AFP response seen after locoregional therapy as an ancillary method of assessing tumor response and survival, as well as an early objective screening tool for progression by imaging.",
author = "Ahsun Riaz and Ryu, {Robert K.} and Kulik, {Laura M.} and Mulcahy, {Mary F.} and Lewandowski, {Robert J.} and Jeet Minocha and Ibrahim, {Saad M.} and Sato, {Kent T.} and Talia Baker and Miller, {Frank H.} and Steven Newman and Reed Omary and Michael Abecassis and Benson, {Al B.} and Riad Salem",
year = "2009",
month = "12",
day = "1",
doi = "10.1200/JCO.2009.23.1282",
language = "English (US)",
volume = "27",
pages = "5734--5742",
journal = "Journal of Clinical Oncology",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "34",

}

TY - JOUR

T1 - Alpha-fetoprotein response after locoregional therapy for hepatocellular carcinoma

T2 - Oncologic marker of radiologic response, progression, and survival

AU - Riaz, Ahsun

AU - Ryu, Robert K.

AU - Kulik, Laura M.

AU - Mulcahy, Mary F.

AU - Lewandowski, Robert J.

AU - Minocha, Jeet

AU - Ibrahim, Saad M.

AU - Sato, Kent T.

AU - Baker, Talia

AU - Miller, Frank H.

AU - Newman, Steven

AU - Omary, Reed

AU - Abecassis, Michael

AU - Benson, Al B.

AU - Salem, Riad

PY - 2009/12/1

Y1 - 2009/12/1

N2 - Purpose: Alpha-fetoprotein (AFP) is considered to be an indicator of tumor activity in hepatocellular carcinoma (HCC). We present a novel correlation of AFP response to radiologic response, time-to-progression (TTP), progression-free survival (PFS), and overall survival (OS) in patients treated with locoregional therapies. Patients and Methods: Four hundred sixty-three patients with HCC were treated with chemoembolization or radioembolization at our institution. One hundred twenty-five patients with baseline AFP higher than 200 ng/mL were studied for this analysis. AFP response was defined as more than 50% decrease from baseline. One hundred nineteen patients with follow-up imaging were studied for the AFP imaging correlation analysis. AFP response was correlated to radiologic response, TTP, PFS, and OS. Multivariate analyses were performed. Results: Eighty-one patients (65%) showed AFP response. AFP response was seen in 26 (55%) of 47 and 55 (70%) of 78 of patients treated with chemoembolization and radioembolization, respectively (P = .12). WHO response was seen in 41 (53%) of 77 and 10 (24%) of 42 of AFP responders and nonresponders, respectively (P = .002). The hazard ratio (HR) for TTP in AFP nonresponders compared with responders was 2.8 (95% CI, 1.5 to 5.1). The HR for PFS was 4.2 (95% CI, 2.4 to 7.2) in AFP nonresponders compared with responders. The HR for OS in AFP nonresponders compared with responders was 5.5 (95% CI, 3.1 to 9.9) and 2.7 (95% CI, 1.6 to 4.6) on univariate and multivariate analyses, respectively. Conclusion: The data presented support the use of AFP response seen after locoregional therapy as an ancillary method of assessing tumor response and survival, as well as an early objective screening tool for progression by imaging.

AB - Purpose: Alpha-fetoprotein (AFP) is considered to be an indicator of tumor activity in hepatocellular carcinoma (HCC). We present a novel correlation of AFP response to radiologic response, time-to-progression (TTP), progression-free survival (PFS), and overall survival (OS) in patients treated with locoregional therapies. Patients and Methods: Four hundred sixty-three patients with HCC were treated with chemoembolization or radioembolization at our institution. One hundred twenty-five patients with baseline AFP higher than 200 ng/mL were studied for this analysis. AFP response was defined as more than 50% decrease from baseline. One hundred nineteen patients with follow-up imaging were studied for the AFP imaging correlation analysis. AFP response was correlated to radiologic response, TTP, PFS, and OS. Multivariate analyses were performed. Results: Eighty-one patients (65%) showed AFP response. AFP response was seen in 26 (55%) of 47 and 55 (70%) of 78 of patients treated with chemoembolization and radioembolization, respectively (P = .12). WHO response was seen in 41 (53%) of 77 and 10 (24%) of 42 of AFP responders and nonresponders, respectively (P = .002). The hazard ratio (HR) for TTP in AFP nonresponders compared with responders was 2.8 (95% CI, 1.5 to 5.1). The HR for PFS was 4.2 (95% CI, 2.4 to 7.2) in AFP nonresponders compared with responders. The HR for OS in AFP nonresponders compared with responders was 5.5 (95% CI, 3.1 to 9.9) and 2.7 (95% CI, 1.6 to 4.6) on univariate and multivariate analyses, respectively. Conclusion: The data presented support the use of AFP response seen after locoregional therapy as an ancillary method of assessing tumor response and survival, as well as an early objective screening tool for progression by imaging.

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U2 - 10.1200/JCO.2009.23.1282

DO - 10.1200/JCO.2009.23.1282

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JO - Journal of Clinical Oncology

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