Favorable alpha-fetoprotein decrease as a prognostic surrogate in patients with hepatocellular carcinoma after radiofrequency ablation.
OBJECTIVE
To assess the significance of adequate alpha-fetoprotein decrease in monitoring the treatment effects of radiofrequency ablation (RFA) in hepatocellular carcinoma (HCC) patients.


METHODS
A total of 72 RFA treatments in 54 HCC patients were analyzed. The favorable alpha-fetoprotein decrease was defined as the alpha-fetoprotein half-life of less than 7 days. The efficacy of the ablation response is assessed by standard imaging modality, a computed tomography scan 1 month after RFA. We assessed the correlation between different alpha-fetoprotein decreases and treatment outcomes by standard imaging modality.


RESULTS
Of the 72 therapies, 15 (21%) were favorable alpha-fetoprotein decreases. Fifty-one (71%) therapies showed concordant results through standard image modality and alpha-fetoprotein decrease, including 14 (27%) therapies with a complete radiological response and favorable alpha-fetoprotein decrease, and the remaining 37 (73%) therapies with an incomplete radiological response and unfavorable alpha-fetoprotein decrease. The accuracy was 70.8% by using alpha-fetoprotein decrease in the detection treatment response based on a complete radiological response. Among the 34 therapies with a complete radiological response, 14 therapies with a favorable alpha-fetoprotein decrease had a better disease-free survival curve than 20 therapies with an unfavorable alpha-fetoprotein decrease (P = 0.003). Only one case had a favorable alpha-fetoprotein decrease, but incomplete radiological response, with massive necrosis, with the exception of a small residual tumor.


CONCLUSIONS
A favorable alpha-fetoprotein decrease has better predictive power for disease-free survival than for an unfavorable alpha-fetoprotein decrease. HCC patients after RFA with an unfavorable alpha-fetoprotein decrease should be considered to have undergone incomplete treatment, despite the complete response by standard image modality post-RFA.
Tsai
Ming-Chao
MC
Department of Internal Medicine, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Wang
Jing-Houng
JH
Hung
Chao-Hung
CH
Kee
Kwong-Ming
KM
Yen
Yi-Hao
YH
Lee
Chuan-Mo
CM
Hu
Tsung-Hui
TH
Chen
Chien-Hung
CH
Lu
Sheng-Nan
SN
D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery*; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000378:metabolism*
D014408:Biomarkers, Tumor; D000509:alpha-Fetoproteins