The resurrection of alphafetoprotein.
OBJECTIVE
Alphafetoprotein (AFP) is considered to be an indicator of tumour 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 200ng/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, 1.5-5.1). The HR for PFS was 4.2 (95% CI, 2.4-7.2) in AFP nonresponders compared with responders. The HR for OS in AFP nonresponders compared with responders was 5.5 (95% CI, 3.1-9.9) and 2.7 (95% CI, 1.6- 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 tumour response and survival, as well as an early objective screening tool for progression by imaging.
Sherman
Morris
M
Department of Medicine, University of Toronto and University Health Network, Toronto, Canada. morris.sherman@uhn.on.ca