Riaz Ahsun, Ryu Robert K, Kulik Laura M, Mulcahy Mary F, Lewandowski Robert J, Minocha Jeet, Ibrahim Saad M, Sato Kent T, Baker Talia, Miller Frank H, Newman Steven, Omary Reed, Abecassis Michael, Benson Al B, Salem Riad
Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL 60611, USA.
J Clin Oncol. 2009 Dec 1;27(34):5734-42. doi: 10.1200/JCO.2009.23.1282. Epub 2009 Oct 5.
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.
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.
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.
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.
甲胎蛋白（AFP）被认为是肝细胞癌（HCC）肿瘤活性的一个指标。我们展示了接受局部区域治疗的患者中，AFP反应与放射学反应、疾病进展时间（TTP）、无进展生存期（PFS）和总生存期（OS）之间的一种新的相关性。
在我们机构，463例HCC患者接受了化疗栓塞或放射性栓塞治疗。对125例基线AFP高于200 ng/mL的患者进行了此项分析。AFP反应定义为较基线水平降低超过50%。对119例有随访影像学检查的患者进行了AFP与影像学相关性分析。将AFP反应与放射学反应、TTP、PFS和OS进行关联分析。进行了多变量分析。
81例患者（65%）显示出AFP反应。接受化疗栓塞和放射性栓塞治疗的患者中，分别有26例（55%）/47例和55例（70%）/78例出现AFP反应（P = 0.12）。AFP反应者和无反应者中，分别有41例（53%）/77例和10例（24%）/42例出现WHO反应（P = 0.002）。与反应者相比，AFP无反应者的TTP风险比（HR）为2.8（95%CI，1.5至5.1）。与反应者相比，AFP无反应者的PFS的HR为4.2（95%CI，2.4至7.2）。单变量和多变量分析中，与反应者相比，AFP无反应者的OS的HR分别为5.5（95%CI，3.1至9.9）和2.7（95%CI，1.6至4.6）。
所呈现的数据支持将局部区域治疗后出现的AFP反应用作评估肿瘤反应和生存的辅助方法，以及通过影像学进行疾病进展的早期客观筛查工具。
