Masior Łukasz, Krasnodębski Maciej, Kuncewicz Mikołaj, Karaban Kacper, Jaszczyszyn Igor, Kruk Emilia, Małecka-Giełdowska Milena, Korzeniowski Krzysztof, Figiel Wojciech, Krawczyk Marek, Wróblewski Tadeusz, Grąt Michał
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, 02-097 Warsaw, Poland.
Department of Laboratory Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland.
Cancers (Basel). 2023 Aug 4;15(15):3962. doi: 10.3390/cancers15153962.
Transarterial chemoembolization (TACE) is used as a bridging treatment in liver transplant candidates with hepatocellular carcinoma (HCC). Alpha-fetoprotein (AFP) is the main tumor marker used for HCC surveillance. The aim of this study was to assess the potential of using the AFP change after the first TACE in the prediction of complete tumor necrosis. The study comprised 101 patients with HCC who underwent liver transplantation (LT) after TACE in the period between January 2011 and December 2020. The ΔAFP was defined as the difference between the AFP value before the first TACE and AFP either before the second TACE or the LT. The receiver operator characteristics (ROC) curves were used to identify an optimal cut-off value. Complete tumor necrosis was found in 26.1% (18 of 69) and 6.3% (2 of 32) of patients with an initial AFP level under and over 100 ng/mL, respectively ( = 0.020). The optimal cut-off value of ΔAFP for the prediction of complete necrosis was a decline of ≥10.2 ng/mL and ≥340.5 ng/mL in the corresponding subgroups. Complete tumor necrosis rates were: 62.5% (5 of 8) in patients with an initial AFP < 100 ng/mL and decline of ≥10.2 ng/mL; 21.3% (13 of 61) in patients with an initial AFP < 100 ng/mL and decline of <10.2 ng/mL; 16.7% (2 of 12) in patients with an initial AFP > 100 ng/mL and decline of ≥340.5 ng/mL; and null in 20 patients with an initial AFP > 100 ng/mL and decline of <340.5 ng/mL, respectively ( = 0.003). The simple scoring system, based on the initial AFP and AFP decline after the first treatment, distinguished between a high, intermediate and low probability of complete necrosis, with an area under the ROC curve of 0.699 (95% confidence intervals 0.577 to 0.821, = 0.001). Combining the initial AFP with its change after the first treatment enables early identification of the efficacy of TACE.
经动脉化疗栓塞术（TACE）被用作肝细胞癌（HCC）肝移植候选患者的桥接治疗。甲胎蛋白（AFP）是用于HCC监测的主要肿瘤标志物。本研究的目的是评估首次TACE后AFP变化在预测肿瘤完全坏死方面的潜力。该研究纳入了2011年1月至2020年12月期间接受TACE后行肝移植（LT）的101例HCC患者。ΔAFP定义为首次TACE前的AFP值与第二次TACE前或LT前的AFP值之差。采用受试者操作特征（ROC）曲线确定最佳临界值。初始AFP水平低于和高于100 ng/mL的患者中，分别有26.1%（69例中的18例）和6.3%（32例中的2例）出现肿瘤完全坏死（P = 0.020）。相应亚组中，预测完全坏死的ΔAFP最佳临界值分别为下降≥10.2 ng/mL和≥340.5 ng/mL。肿瘤完全坏死率分别为：初始AFP < 100 ng/mL且下降≥10.2 ng/mL的患者中为62.5%（8例中的5例）；初始AFP < 100 ng/mL且下降<10.2 ng/mL的患者中为21.3%（61例中的13例）；初始AFP > 100 ng/mL且下降≥340.5 ng/mL的患者中为16.7%（12例中的2例）；初始AFP > 100 ng/mL且下降<340.5 ng/mL的20例患者中无完全坏死病例（P = 0.003）。基于初始AFP和首次治疗后AFP下降情况的简单评分系统，可区分完全坏死的高、中、低概率，ROC曲线下面积为0.699（95%置信区间0.577至0.821，P = 0.001）。将初始AFP与其首次治疗后的变化相结合，能够早期识别TACE的疗效。
