title: Tumor Markers AFP, AFP-L3, and DCP in Hepatocellular Carcinoma Refractory to Transcatheter Arterial Chemoembolization.
abstract: OBJECTIVE
  We examined tumor marker levels to assess in more detail transcatheter arterial chemoembolization (TACE)-refractory hepatocellular carcinoma (HCC).
  
  
  METHODS
  We enrolled patients treated from 2000 to 2011 for HCC beyond the Milan criteria who had good hepatic reserve function (Child-Pugh A) and no portal vein thrombosis or metastases (n = 154). The modified criteria for being TACE-refractory according to the Liver Cancer Study Group of Japan (m-LCSGJ), from which the tumor marker item was excluded, and the Assessment for Retreatment with TACE (ART) score were used for determining whether the HCC was TACE refractory. α-Fetoprotein ≥ 100 ng/ml, fucosylated α-fetoprotein ≥ 10%, and des-gamma-carboxy prothrombin ≥ 100 mAU/ml were used to define whether tumor markers were positive. We added up the number of positive tumor markers as a prognostic score to assess in more detail the evaluation of TACE-refractory HCC.
  
  
  RESULTS
  In order to divide the patients into a refractory and nonrefractory group, the m-LCSGJ criteria [mean survival time (MST) 27.1 vs. 49.9 months; p < 0.001] were superior to the ART score (MST 22.0 vs. 35.1 months; p = 0.051). In the refractory group according to the m-LCSGJ criteria, the patients with a low score of positive tumor markers (<2) after 2 sessions of TACE (n = 36) showed a better prognosis than the others (n = 72) (MST 37.7 vs. 23.2 months; p = 0.014).
  
  
  CONCLUSIONS
  Patients being nonrefractory according to the m-LCSGJ criteria had a better response, and using the number of tumor markers (≥ 2) is an easy method for predicting the response to TACE and for a more detailed evaluation of TACE-refractory HCC.
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hiraoka
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Ishimaru
authors.forename: Hideki
authors.initials: H
authors.lastname: Kawasaki
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Aibiki
authors.forename: Tomonari
authors.initials: T
authors.lastname: Okudaira
authors.forename: Akiko
authors.initials: A
authors.lastname: Toshimori
authors.forename: Tomoe
authors.initials: T
authors.lastname: Kawamura
authors.forename: Hiroka
authors.initials: H
authors.lastname: Yamago
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Nakahara
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Suga
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Azemoto
authors.forename: Hideki
authors.initials: H
authors.lastname: Miyata
authors.forename: Yasunao
authors.initials: Y
authors.lastname: Miyamoto
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Ninomiya
authors.forename: Masashi
authors.initials: M
authors.lastname: Hirooka
authors.forename: Masanori
authors.initials: M
authors.lastname: Abe
authors.forename: Bunzo
authors.initials: B
authors.lastname: Matsuura
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Hiasa
authors.forename: Kojiro
authors.initials: K
authors.lastname: Michitaka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D014408:Biomarkers, Tumor / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D005260:Female; D005643:Fucose / Q000378:metabolism; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D011516:Prothrombin; D017211:Treatment Failure; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000378:metabolism*
chemical_list: C097353:AFP protein, human; D015415:Biomarkers; D014408:Biomarkers, Tumor; D011498:Protein Precursors; D000509:alpha-Fetoproteins; D005643:Fucose; C008208:acarboxyprothrombin; D011516:Prothrombin