title: Alpha-fetoprotein response after locoregional therapy for hepatocellular carcinoma: oncologic marker of radiologic response, progression, and survival.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL 60611, USA.
authors.forename: Ahsun
authors.initials: A
authors.lastname: Riaz
authors.forename: Robert K
authors.initials: RK
authors.lastname: Ryu
authors.forename: Laura M
authors.initials: LM
authors.lastname: Kulik
authors.forename: Mary F
authors.initials: MF
authors.lastname: Mulcahy
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lewandowski
authors.forename: Jeet
authors.initials: J
authors.lastname: Minocha
authors.forename: Saad M
authors.initials: SM
authors.lastname: Ibrahim
authors.forename: Kent T
authors.initials: KT
authors.lastname: Sato
authors.forename: Talia
authors.initials: T
authors.lastname: Baker
authors.forename: Frank H
authors.initials: FH
authors.lastname: Miller
authors.forename: Steven
authors.initials: S
authors.lastname: Newman
authors.forename: Reed
authors.initials: R
authors.lastname: Omary
authors.forename: Michael
authors.initials: M
authors.lastname: Abecassis
authors.forename: Al B
authors.initials: AB
authors.lastname: Benson
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000000981:diagnostic imaging* / Q000532:radiotherapy / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000000981:diagnostic imaging* / Q000532:radiotherapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D015996:Survival Rate; D015020:Yttrium Isotopes / Q000008:administration & dosage; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D014408:Biomarkers, Tumor; D019275:Radiopharmaceuticals; D015020:Yttrium Isotopes; D000509:alpha-Fetoproteins