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Prognostic Value of Alpha-Fetoprotein in Patients Who Achieve a Complete Response to Transarterial Chemoembolization for Hepatocellular Carcinoma

 Jae Seung Lee  ;  Young Eun Chon  ;  Beom Kyung Kim  ;  Jun Yong Park  ;  Do Young Kim  ;  Sang Hoon Ahn  ;  Kwang Hyub Han  ;  Wonseok Kang  ;  Moon Seok Choi  ;  Geum Youn Gwak  ;  Yong Han Paik  ;  Joon Hyeok Lee  ;  Kwang Cheol Koh  ;  Seung Woon Paik  ;  Hwi Young Kim  ;  Tae Hun Kim  ;  Kwon Yoo  ;  Yeonjung Ha  ;  Mi Na Kim  ;  Joo Ho Lee  ;  Seong Gyu Hwang  ;  Soon Sun Kim  ;  Hyo Jung Cho  ;  Jae Youn Cheong  ;  Sung Won Cho  ;  Seung Ha Park  ;  Nae Yun Heo  ;  Young Mi Hong  ;  Ki Tae Yoon  ;  Mong Cho  ;  Jung Gil Park  ;  Min Kyu Kang  ;  Soo Young Park  ;  Young Oh Kweon  ;  Won Young Tak  ;  Se Young Jang  ;  Dong Hyun Sinn  ;  Seung Up Kim 
 YONSEI MEDICAL JOURNAL, Vol.62(1) : 12-20, 2021-01 
Journal Title
Issue Date
Adult ; Aged ; Arteries* ; Carcinoma, Hepatocellular / diagnosis ; Carcinoma, Hepatocellular / metabolism ; Carcinoma, Hepatocellular / therapy* ; Chemoembolization, Therapeutic* / adverse effects ; Female ; Humans ; Liver Neoplasms / diagnosis ; Liver Neoplasms / metabolism ; Liver Neoplasms / therapy* ; Male ; Middle Aged ; Prognosis ; Proportional Hazards Models ; Recurrence ; Treatment Outcome ; Venous Thrombosis / etiology ; alpha-Fetoproteins / metabolism*
Carcinoma, hepatocellular ; alpha-fetoprotein ; prognosis ; transarterial chemoembolization ; treatment outcome
Purpose: Alpha-fetoprotein (AFP) is a prognostic marker for hepatocellular carcinoma (HCC). We investigated the prognostic value of AFP levels in patients who achieved complete response (CR) to transarterial chemoembolization (TACE) for HCC. Materials and methods: Between 2005 and 2018, 890 patients with HCC who achieved a CR to TACE were recruited. An AFP responder was defined as a patient who showed elevated levels of AFP (>10 ng/mL) during TACE, but showed normalization or a >50% reduction in AFP levels after achieving a CR. Results: Among the recruited patients, 569 (63.9%) with naïve HCC and 321 (36.1%) with recurrent HCC after complete resection were treated. Before TACE, 305 (34.3%) patients had multiple tumors, 219 (24.6%) had a maximal tumor size >3 cm, and 22 (2.5%) had portal vein tumor thrombosis. The median AFP level after achieving a CR was 6.36 ng/mL. After a CR, 473 (53.1%) patients experienced recurrence, and 417 (46.9%) died [median progression-free survival (PFS) and overall survival (OS) of 16.3 and 62.8 months, respectively]. High AFP levels at CR (>20 ng/mL) were independently associated with a shorter PFS [hazard ratio (HR)=1.403] and OS (HR=1.284), together with tumor multiplicity at TACE (HR=1.518 and 1.666, respectively). AFP non-responders at CR (76.2%, n=359 of 471) showed a shorter PFS (median 10.5 months vs. 15.5 months, HR=1.375) and OS (median 41.4 months vs. 61.8 months, HR=1.424) than AFP responders (all p=0.001). Conclusion: High AFP levels and AFP non-responders were independently associated with poor outcomes after TACE. AFP holds clinical implications for detailed risk stratification upon achieving a CR after TACE.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Do Young(김도영)
Kim, Beom Kyung(김범경) ORCID logo https://orcid.org/0000-0002-5363-2496
Kim, Seung Up(김승업) ORCID logo https://orcid.org/0000-0002-9658-8050
Park, Jun Yong(박준용) ORCID logo https://orcid.org/0000-0001-6324-2224
Ahn, Sang Hoon(안상훈) ORCID logo https://orcid.org/0000-0002-3629-4624
Lee, Jae Seung(이재승) ORCID logo https://orcid.org/0000-0002-2371-0967
Han, Kwang-Hyub(한광협) ORCID logo https://orcid.org/0000-0003-3960-6539
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