title: Favorable alpha-fetoprotein decrease as a prognostic surrogate in patients with hepatocellular carcinoma after radiofrequency ablation.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Ming-Chao
authors.initials: MC
authors.lastname: Tsai
authors.forename: Jing-Houng
authors.initials: JH
authors.lastname: Wang
authors.forename: Chao-Hung
authors.initials: CH
authors.lastname: Hung
authors.forename: Kwong-Ming
authors.initials: KM
authors.lastname: Kee
authors.forename: Yi-Hao
authors.initials: YH
authors.lastname: Yen
authors.forename: Chuan-Mo
authors.initials: CM
authors.lastname: Lee
authors.forename: Tsung-Hui
authors.initials: TH
authors.lastname: Hu
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Chen
authors.forename: Sheng-Nan
authors.initials: SN
authors.lastname: Lu
mesh_terms: 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*
chemical_list: D014408:Biomarkers, Tumor; D000509:alpha-Fetoproteins