title: Changes in serum α-fetoprotein level predicts treatment response and survival in hepatocellular carcinoma patients and literature review.
abstract: BACKGROUND
  Oxaliplatin-based chemotherapy is an alternative systemic treatment for patients with metastatic hepatocellular carcinoma (HCC) who were refractory or intolerant to sorafenib. To date, there have been no biomarkers reported to monitor the therapeutic efficacy and to predict the outcomes of HCC patients receiving oxaliplatin-based chemotherapy.
  
  
  METHODS
  Eighty-one HCC patients with elevated baseline α-fetoprotein (AFP) levels and extrahepatic spreading who received oxaliplatin-based chemotherapy between 2012 and 2014 were retrospectively enrolled in this study. Two AFP tests were performed, at baseline and 2-4 weeks after the initiation of chemotherapy. The change in AFP levels was calculated for survival analysis.
  
  
  RESULTS
  In the AFP decline group (decreased compared to baseline), the median progression-free survival (PFS) and overall survival (OS) were 7.0 months and 12.3 months, respectively. In the AFP nondecline group, the median PFS and OS were 2.3 months and 3.0 months, respectively. The difference in OS between the two groups was significant (p < 0.005). In the multivariate analysis for disease progression, the best response to chemotherapy and AFP decline were independent factors, with p values of 0.004 and 0.009, respectively. In the multivariate analysis for OS, the baseline Child-Pugh score, best response to chemotherapy, and AFP decline were independent prognostic factors, with p values of 0.01, 0.001, and 0.008, respectively. Additionally, the unit change in AFP level was predictive of PFS and OS with p values of 0.007 and 0.001, respectively.
  
  
  CONCLUSIONS
  The change in AFP levels 2-4 weeks after initiating oxaliplatin-based chemotherapy is useful to predict treatment response and survival.
authors.affiliation: Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Chang Gung University, Taoyuan, Taiwan.
authors.forename: Wen-Chi
authors.initials: WC
authors.lastname: Chou
authors.affiliation: Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan; Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Chia-Lin
authors.initials: CL
authors.lastname: Lee
authors.affiliation: Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Chang Gung University, Taoyuan, Taiwan.
authors.forename: Tsai-Sheng
authors.initials: TS
authors.lastname: Yang
authors.affiliation: Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chen-Yang
authors.initials: CY
authors.lastname: Huang
authors.affiliation: Chang Gung University, Taoyuan, Taiwan; Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Wei
authors.initials: W
authors.lastname: Teng
authors.affiliation: Chang Gung University, Taoyuan, Taiwan; Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Ya-Ting
authors.initials: YT
authors.lastname: Tseng
authors.affiliation: Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Chang Gung University, Taoyuan, Taiwan.
authors.forename: Jen-Shi
authors.initials: JS
authors.lastname: Chen
authors.affiliation: Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yung-Chang
authors.initials: YC
authors.lastname: Lin
authors.affiliation: Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Chang Gung University, Taoyuan, Taiwan.
authors.forename: Ming-Mo
authors.initials: MM
authors.lastname: Hou
authors.affiliation: Chang Gung University, Taoyuan, Taiwan; Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan.
authors.forename: Ho-Hsiang
authors.initials: HH
authors.lastname: Chang
authors.affiliation: Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Chemical and Materials Engineering, Chang Gung University, Taoyuan, Taiwan. Electronic address: wisdom5000@gmail.com.
authors.forename: Jason
authors.initials: J
authors.lastname: Chia-Hsun Hsieh
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000188:drug therapy / Q000401:mortality*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009536:Niacinamide / Q000031:analogs & derivatives / Q000627:therapeutic use; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D000077150:Oxaliplatin; D010671:Phenylurea Compounds / Q000627:therapeutic use; D012189:Retrospective Studies; D012720:Severity of Illness Index; D000077157:Sorafenib; D016019:Survival Analysis; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D009944:Organoplatinum Compounds; D010671:Phenylurea Compounds; D000509:alpha-Fetoproteins; D000077150:Oxaliplatin; D009536:Niacinamide; D000077157:Sorafenib
keywords: changes; chemotherapy; hepatocellular carcinoma; oxaliplatin; α-fetoprotein