Alpha-fetoprotein response correlates with EASL response and survival in solitary hepatocellular carcinoma treated with transarterial therapies

A subgroup analysis

Khairuddin Memon, Laura Kulik, Robert J. Lewandowski, Edward Wang, Robert K. Ryu, Ahsun Riaz, Paul Nikolaidis, Frank H. Miller, Vahid Yaghmai, Talia Baker, Michael Abecassis, Al B. Benson, Mary F. Mulcahy, Reed A. Omary, Riad Salem*

*Corresponding author for this work

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Background & Aims: Alpha-fetoprotein (AFP) is a universally recognized tumor marker in hepatocellular carcinoma (HCC). Its utility in assessing response to treatment remains controversial. We sought to study the: (a) correlation between AFP response and imaging response, and (b) ability of AFP, EASL, and WHO response to predict survival outcomes in patients with solitary HCC. Methods: Six hundred and twenty-nine HCC patients were treated with transarterial locoregional therapies over an 11-year period. To eliminate confounding factors, we included patients with single tumors, baseline AFP ≥200 ng/ml, and no extrahepatic disease; this identified our study cohort of 51 patients. AFP response was defined as >50% decrease from baseline; this was correlated to EASL and WHO response criteria by Kappa agreement, Pearson correlation and receiver operating curves. Survival analyses were performed by Landmark, risk-of-death and Mantel-Byar methodologies. None of the patients received sorafenib. Results: Three months post-treatment, AFP and EASL response correlated well (Kappa: 0.83; Pearson: 0.84); the sensitivity, specificity, positive and negative predictive values of AFP in predicting EASL response at 3 months were 96.6%, 85.7%, 92.3%, and 93.3%, respectively. Correlation with WHO response was low. From the 3-month landmark, WHO, EASL, and AFP responders survived longer than non-responders (p = 0.006, 0.0001, and <0.0001, respectively). The risk of death was lower for EASL and AFP responders by both risk-of-death and Mantel-Byar methodologies (p <0.05). Conclusions: Response by AFP and EASL are predictors of survival outcome in patients with solitary HCC. AFP correlates with imaging response assessment by EASL guidelines. Achieving AFP response should be one of the therapeutic intents of locoregional therapies (LRTs).

Original languageEnglish (US)
Pages (from-to)1112-1120
Number of pages9
JournalJournal of Hepatology
Volume56
Issue number5
DOIs
StatePublished - May 1 2012

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alpha-Fetoproteins
Hepatocellular Carcinoma
Survival
Therapeutics
Survival Analysis
Tumor Biomarkers
Cohort Studies
Guidelines

Keywords

  • AFP response
  • Correlation
  • Hepatocellular carcinoma
  • Imaging response
  • Radioembolization
  • Survival
  • Transarterial chemoembolization

ASJC Scopus subject areas

  • Hepatology

Cite this

@article{9302c48c02c346f1a5f40ba4616b3b8b,
title = "Alpha-fetoprotein response correlates with EASL response and survival in solitary hepatocellular carcinoma treated with transarterial therapies: A subgroup analysis",
abstract = "Background & Aims: Alpha-fetoprotein (AFP) is a universally recognized tumor marker in hepatocellular carcinoma (HCC). Its utility in assessing response to treatment remains controversial. We sought to study the: (a) correlation between AFP response and imaging response, and (b) ability of AFP, EASL, and WHO response to predict survival outcomes in patients with solitary HCC. Methods: Six hundred and twenty-nine HCC patients were treated with transarterial locoregional therapies over an 11-year period. To eliminate confounding factors, we included patients with single tumors, baseline AFP ≥200 ng/ml, and no extrahepatic disease; this identified our study cohort of 51 patients. AFP response was defined as >50{\%} decrease from baseline; this was correlated to EASL and WHO response criteria by Kappa agreement, Pearson correlation and receiver operating curves. Survival analyses were performed by Landmark, risk-of-death and Mantel-Byar methodologies. None of the patients received sorafenib. Results: Three months post-treatment, AFP and EASL response correlated well (Kappa: 0.83; Pearson: 0.84); the sensitivity, specificity, positive and negative predictive values of AFP in predicting EASL response at 3 months were 96.6{\%}, 85.7{\%}, 92.3{\%}, and 93.3{\%}, respectively. Correlation with WHO response was low. From the 3-month landmark, WHO, EASL, and AFP responders survived longer than non-responders (p = 0.006, 0.0001, and <0.0001, respectively). The risk of death was lower for EASL and AFP responders by both risk-of-death and Mantel-Byar methodologies (p <0.05). Conclusions: Response by AFP and EASL are predictors of survival outcome in patients with solitary HCC. AFP correlates with imaging response assessment by EASL guidelines. Achieving AFP response should be one of the therapeutic intents of locoregional therapies (LRTs).",
keywords = "AFP response, Correlation, Hepatocellular carcinoma, Imaging response, Radioembolization, Survival, Transarterial chemoembolization",
author = "Khairuddin Memon and Laura Kulik and Lewandowski, {Robert J.} and Edward Wang and Ryu, {Robert K.} and Ahsun Riaz and Paul Nikolaidis and Miller, {Frank H.} and Vahid Yaghmai and Talia Baker and Michael Abecassis and Benson, {Al B.} and Mulcahy, {Mary F.} and Omary, {Reed A.} and Riad Salem",
year = "2012",
month = "5",
day = "1",
doi = "10.1016/j.jhep.2011.11.020",
language = "English (US)",
volume = "56",
pages = "1112--1120",
journal = "Journal of Hepatology",
issn = "0168-8278",
publisher = "Elsevier",
number = "5",

}

TY - JOUR

T1 - Alpha-fetoprotein response correlates with EASL response and survival in solitary hepatocellular carcinoma treated with transarterial therapies

T2 - A subgroup analysis

AU - Memon, Khairuddin

AU - Kulik, Laura

AU - Lewandowski, Robert J.

AU - Wang, Edward

AU - Ryu, Robert K.

AU - Riaz, Ahsun

AU - Nikolaidis, Paul

AU - Miller, Frank H.

AU - Yaghmai, Vahid

AU - Baker, Talia

AU - Abecassis, Michael

AU - Benson, Al B.

AU - Mulcahy, Mary F.

AU - Omary, Reed A.

AU - Salem, Riad

PY - 2012/5/1

Y1 - 2012/5/1

N2 - Background & Aims: Alpha-fetoprotein (AFP) is a universally recognized tumor marker in hepatocellular carcinoma (HCC). Its utility in assessing response to treatment remains controversial. We sought to study the: (a) correlation between AFP response and imaging response, and (b) ability of AFP, EASL, and WHO response to predict survival outcomes in patients with solitary HCC. Methods: Six hundred and twenty-nine HCC patients were treated with transarterial locoregional therapies over an 11-year period. To eliminate confounding factors, we included patients with single tumors, baseline AFP ≥200 ng/ml, and no extrahepatic disease; this identified our study cohort of 51 patients. AFP response was defined as >50% decrease from baseline; this was correlated to EASL and WHO response criteria by Kappa agreement, Pearson correlation and receiver operating curves. Survival analyses were performed by Landmark, risk-of-death and Mantel-Byar methodologies. None of the patients received sorafenib. Results: Three months post-treatment, AFP and EASL response correlated well (Kappa: 0.83; Pearson: 0.84); the sensitivity, specificity, positive and negative predictive values of AFP in predicting EASL response at 3 months were 96.6%, 85.7%, 92.3%, and 93.3%, respectively. Correlation with WHO response was low. From the 3-month landmark, WHO, EASL, and AFP responders survived longer than non-responders (p = 0.006, 0.0001, and <0.0001, respectively). The risk of death was lower for EASL and AFP responders by both risk-of-death and Mantel-Byar methodologies (p <0.05). Conclusions: Response by AFP and EASL are predictors of survival outcome in patients with solitary HCC. AFP correlates with imaging response assessment by EASL guidelines. Achieving AFP response should be one of the therapeutic intents of locoregional therapies (LRTs).

AB - Background & Aims: Alpha-fetoprotein (AFP) is a universally recognized tumor marker in hepatocellular carcinoma (HCC). Its utility in assessing response to treatment remains controversial. We sought to study the: (a) correlation between AFP response and imaging response, and (b) ability of AFP, EASL, and WHO response to predict survival outcomes in patients with solitary HCC. Methods: Six hundred and twenty-nine HCC patients were treated with transarterial locoregional therapies over an 11-year period. To eliminate confounding factors, we included patients with single tumors, baseline AFP ≥200 ng/ml, and no extrahepatic disease; this identified our study cohort of 51 patients. AFP response was defined as >50% decrease from baseline; this was correlated to EASL and WHO response criteria by Kappa agreement, Pearson correlation and receiver operating curves. Survival analyses were performed by Landmark, risk-of-death and Mantel-Byar methodologies. None of the patients received sorafenib. Results: Three months post-treatment, AFP and EASL response correlated well (Kappa: 0.83; Pearson: 0.84); the sensitivity, specificity, positive and negative predictive values of AFP in predicting EASL response at 3 months were 96.6%, 85.7%, 92.3%, and 93.3%, respectively. Correlation with WHO response was low. From the 3-month landmark, WHO, EASL, and AFP responders survived longer than non-responders (p = 0.006, 0.0001, and <0.0001, respectively). The risk of death was lower for EASL and AFP responders by both risk-of-death and Mantel-Byar methodologies (p <0.05). Conclusions: Response by AFP and EASL are predictors of survival outcome in patients with solitary HCC. AFP correlates with imaging response assessment by EASL guidelines. Achieving AFP response should be one of the therapeutic intents of locoregional therapies (LRTs).

KW - AFP response

KW - Correlation

KW - Hepatocellular carcinoma

KW - Imaging response

KW - Radioembolization

KW - Survival

KW - Transarterial chemoembolization

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U2 - 10.1016/j.jhep.2011.11.020

DO - 10.1016/j.jhep.2011.11.020

M3 - Article

VL - 56

SP - 1112

EP - 1120

JO - Journal of Hepatology

JF - Journal of Hepatology

SN - 0168-8278

IS - 5

ER -