Department of Internal Medicine, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea.
Liver Int. 2011 Mar;31(3):369-76. doi: 10.1111/j.1478-3231.2010.02368.x. Epub 2010 Nov 17.
There are limitations in using only radiological criteria to evaluate treatment outcomes in hepatocellular carcinoma (HCC). α-fetoprotein (AFP) is regarded as an indicator of tumour activity in HCC.
We present a novel correlation between AFP response and survival outcome in patients treated with localized concurrent chemoradiotherapy (CCRT).
From 2005 to 2008, 187 locally advanced HCC patients underwent localized CCRT (external beam radiotherapy at 45 Gy over 5 weeks plus a concurrent hepatic arterial infusion of 5-fluorouracil during the first/fifth week), followed by repetitive hepatic arterial infusional chemotherapy (HAIC) with 5-fluorouracil and cisplatin. Among them, 149 with an elevated baseline AFP level (>20 ng/ml) were finally studied. AFP response was defined as >50% decrease from baseline, 1 month after the completion of localized CCRT.
Patients' characteristics were as follows: median age (52 years); Child-Pugh class A/B (n=137/12 respectively); and portal vein thrombosis (n=118). AFP responders (101 patients) had better objective responses than AFP non-responders (48 patients) after CCRT (44.5 vs. 12.5%; P<0.001) and subsequent HAIC (51.5 vs. 16.7%; P<0.001). Both median progression-free survival (PFS, 8.1 vs. 3.9 months; P<0.001) and overall survival (OS, 13.3 vs. 5.9 months; P<0.001) were longer in AFP responders than AFP non-responders. In multivariate analysis, AFP response and objective response were independent factors affecting PFS and OS. Furthermore, AFP non-responders were more likely to have extrahepatic metastasis within 6 months of treatments initiation than AFP responders (59.5 vs. 25.9%; P<0.001).
Early AFP response may be useful not only in predicting prognosis and treatment response but also in establishing optimized treatment plans for HCC.
仅使用影像学标准来评估肝细胞癌 (HCC) 的治疗效果存在局限性。甲胎蛋白 (AFP) 被认为是 HCC 肿瘤活性的指标。
我们提出了一种新的 AFP 反应与接受局部同步放化疗 (CCRT) 治疗的患者生存结局之间的相关性。
2005 年至 2008 年，187 例局部晚期 HCC 患者接受局部 CCRT（5 周内 45Gy 外照射放疗，第 1/5 周同时行肝动脉内氟尿嘧啶输注），随后行重复肝动脉输注化疗（HAIC），药物为氟尿嘧啶和顺铂。其中，最终有 149 例 AFP 基线水平升高（>20ng/ml）的患者被纳入研究。AFP 反应定义为 CCRT 完成后 1 个月 AFP 基线水平下降>50%。
患者特征如下：中位年龄（52 岁）；Child-Pugh 分级 A/B（分别为 137/12 例）；门静脉血栓形成（118 例）。与 AFP 无应答者（48 例）相比，CCRT 后（44.5% vs. 12.5%；P<0.001）和随后 HAIC 后（51.5% vs. 16.7%；P<0.001），AFP 应答者（101 例）的客观反应更好。AFP 应答者的中位无进展生存期（PFS，8.1 个月 vs. 3.9 个月；P<0.001）和总生存期（OS，13.3 个月 vs. 5.9 个月；P<0.001）均长于 AFP 无应答者。多因素分析显示，AFP 反应和客观反应是影响 PFS 和 OS 的独立因素。此外，与 AFP 应答者相比，AFP 无应答者在治疗开始后 6 个月内更有可能发生肝外转移（59.5% vs. 25.9%；P<0.001）。
早期 AFP 反应不仅有助于预测预后和治疗反应，还有助于为 HCC 患者制定优化的治疗方案。
