title: Early increase in α-fetoprotein for predicting unfavorable clinical outcomes in patients with advanced hepatocellular carcinoma treated with sorafenib.
abstract: BACKGROUND
  To determine the value of early alterations of the tumor markers α-fetoprotein (AFP) and des-γ-carboxy prothrombin (DCP) for predicting the outcomes of patients with advanced hepatocellular carcinoma (HCC) who receive sorafenib.
  
  
  METHODS
  Tumor response, overall survival (OS), and progression-free survival (PFS) were retrospectively analyzed in 59 patients with advanced HCC. Serum AFP and DCP were examined for early elevation within 4 weeks after the initiation of sorafenib. An increase in AFP was defined as AFP of more than 20%, and an increase in DCP was defined as more than two-fold higher level than the baseline. The relationship of the clinical characteristics, laboratory data at baseline, and early elevations of AFP and DCP with disease progression was analyzed.
  
  
  RESULTS
  The median OS and PFS were 11 and 3.3 months, respectively. The rate of progressive disease (PD) was 54%, and an early increase in AFP was significantly related to PD (P=0.006) and was a significant independent predictor of both poorer OS and PFS (P<0.001, hazard ratio, 4.14; 95% confidence interval, 1.946-8.811; and P=0.001, hazard ratio, 2.852; 95% confidence interval, 1.524-5.337, respectively). There was no association between early increase in DCP and clinical outcomes.
  
  
  CONCLUSIONS
  Early increase in AFP predicted PD and poorer survival and may thus be a useful biomarker in patients with advanced HCC who receive sorafenib.
authors: Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Tokyo, Japan. tnakazaw@kitasato-u.ac.jp
authors: Takahide
authors: T
authors: Nakazawa
authors: Hisashi
authors: H
authors: Hidaka
authors: Juichi
authors: J
authors: Takada
authors: Yusuke
authors: Y
authors: Okuwaki
authors: Yoshiaki
authors: Y
authors: Tanaka
authors: Masaaki
authors: M
authors: Watanabe
authors: Akitaka
authors: A
authors: Shibuya
authors: Tsutomu
authors: T
authors: Minamino
authors: Shigehiro
authors: S
authors: Kokubu
authors: Wasaburo
authors: W
authors: Koizumi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D014408:Biomarkers, Tumor / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000188:drug therapy*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009536:Niacinamide / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood; D011516:Prothrombin; D012189:Retrospective Studies; D000077157:Sorafenib; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000378:metabolism*
chemical_list: D000970:Antineoplastic Agents; D015415:Biomarkers; D014408:Biomarkers, Tumor; D010671:Phenylurea Compounds; D011498:Protein Precursors; D000509:alpha-Fetoproteins; D009536:Niacinamide; C008208:acarboxyprothrombin; D011516:Prothrombin; D000077157:Sorafenib