The Potential Value of Alpha-Fetoprotein Classification in Clinical Practice
The potential value of α-fetoprotein (AFP) classification in clinical practice is demonstrated according to a study published in the Journal of Vascular and Interventional Radiology. The results showed that AFP categories agreed moderately with modified Response Evaluation Criteria In Solid Tumors (mRECIST) outcomes and yielded accurate prognostic prediction in patients with unresectable hepatocellular carcinoma (HCC) and AFP levels ≥400 ng/mL treated with chemoembolization.
A total of 147 patients with unresectable HCC were included in the retrospective study. All patients had baseline AFP levels ≥ 400 ng/mL and underwent transarterial chemoembolization as initial treatment between January 2011 and December 2014. AFP-based response was classified as complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) in cases of AFP level normalization, in cases of > 50% decrease vs baseline, in cases of -50% to +30% change vs baseline, and in cases of > 30% increase vs baseline, respectively.
AFP and mRECIST response rates were compared. The association between response rate and overall survival (OS) were evaluated.
The κ value for agreement between AFP criteria and mRECIST was 0.549 (ie, moderate). The objective response rate was 36.1% and the disease control rates was 63.3% per AFP criteria and 34.7% and 46.3% per RECIST (P = 0.807 and P = 0.003), respectively.
Significantly prognostic strata for CR, PR, SD, and PD after chemoembolization was seen according to AFP criteria (P < 0.001) and mRECIST (P < 0.001). However, overlap in radiologic PD survival curves was observed. The OS of AFP-based disease control was significantly longer than AFP-based PD among patients with radiologic PD (9.0 vs 6.0 months; P < 0.001).
“The present study shows that, in patients with unresectable HCC and increased AFP level (≥400 ng/mL) undergoing transarterial chemoembolization, AFP-based and mRECIST responses were independent predictors of OS,” the authors concluded. “A moderate level of correlation between AFP classification criteria and mRECIST responses was observed. AFP responses are independent prognostic factors for survival, and gave accurate prognostic predictions in patients with HCC with AFP levels ≥400 ng/mL after transarterial chemoembolization. Further large prospective studies are needed to verify these results.”
Zhang YQ, Jiang LJ, Wen J, et al. Comparison of α-Fetoprotein Criteria and Modified Response Evaluation Criteria in Solid Tumors for the Prediction of Overall Survival of Patients with Hepatocellular Carcinoma after Transarterial Chemoembolization. J Vasc Interv Radiol. 2018; S1051-0443(18)31408-1408. doi: 10.1016/j.jvir.2018.07.031. [Epub ahead of print].