Serum alpha-fetoprotein response can predict prognosis in hepatocellular carcinoma patients undergoing radiofrequency ablation therapy

Kao, W.-Y.; Chiou, Y.-Y.; Hung, H.-H.; Su, C.-W.; Chou, Y.-H.; Wu, J.-C.; Huo, T.-I.; Huang, Y.-H.; Wu, W.-C.; Lin, H.-C.; Lee, S.-D.

doi:10.1016/j.crad.2011.10.009

« Previous Next »Clinical Radiology
Volume 67, Issue 5 , Pages 429-436, May 2012

Serum alpha-fetoprotein response can predict prognosis in hepatocellular carcinoma patients undergoing radiofrequency ablation therapy

W.-Y. Kao
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taiwan
Y.-Y. Chiou
- Department of Radiology, Taipei Veterans General Hospital, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Guarantor and correspondent: Y.-Y. Chiou, Division of Gastrointestinal Radiology, Department of Radiology, Taipei Veterans General Hospital, 201 Shih-Pai Road, Sec. 2, Taipei 112, Taiwan. Tel.: +886 2 28712121x7594; fax: +886 2 28769310.
H.-H. Hung
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
C.-W. Su
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Guarantor and correspondent: C.-W. Su, Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, 201 Shih-Pai Road, Sec.2, Taipei 112, Taiwan. Tel.: +886 2 28712121x3971; fax: + 886 2 28739318.
Y.-H. Chou
- Department of Radiology, Taipei Veterans General Hospital, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
J.-C. Wu
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Medical Research and Education, Taipei Veterans General Hospital, Taiwan
T.-I. Huo
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taiwan
- Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
Y.-H. Huang
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
W.-C. Wu
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taiwan
H.-C. Lin
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
S.-D. Lee
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

Received 28 June 2011; received in revised form 11 September 2011; accepted 25 October 2011. published online 08 December 2011.

Aims

To evaluate the clinical inference of serum alpha-fetoprotein (AFP) response in hepatocellular carcinoma (HCC) patients undergoing percutaneous radiofrequency ablation (RFA).

Materials and methods

Three hundred and thirteen previously untreated HCC patients were enrolled in the study. The optimal AFP response was defined as >20% decrease from baseline after 1 month of RFA for those with a baseline AFP level of ≥100 ng/ml. The impact of AFP response on prognosis was analysed and prognostic factors were assessed.

Results

After a median follow-up of 26.7 ± 19.1 months, 49 patients died and 264 patients were alive. The cumulative 5 year survival rates were 75.3 and 57.4% in patients with an initial AFP of <100 ng/ml and ≥100 ng/ml, respectively (p = 0.003). In the 58 patients with a baseline AFP of ≥100 ng/ml and initial completed tumour necrosis after RFA, the cumulative 5 year survival rates were 62.4 and 25.7% in optimal and non-optimal AFP responders, respectively (p = 0.001). By multivariate analysis, the prothrombin time international normalized ratio >1.1 (p = 0.009), non-optimal AFP response (p = 0.023), and creatinine >1.5 mg/dl (p = 0.021) were independent risk factors predictive of poor overall survival. Besides, the cumulative 5 year recurrence rates were 83.4 and 100% in optimal and non-optimal AFP responders, respectively (p < 0.001). Multivariate analysis demonstrated platelet count ≤10⁵/mm³ (p = 0.048), tumour size >2 cm (p = 0.027), and non-optimal AFP response (p < 0.001) were independent risk factors associated with tumour recurrence after RFA.