The Dynamic Changes of AFP From Baseline to Recurrence as an Excellent Prognostic Factor of Hepatocellular Carcinoma After Locoregional Therapy: A 5-Year Prospective Cohort Study

Abstract

BackgroundAlthough many studies have confirmed the prognostic value of preoperative alpha-fetoprotein (AFP) in patients with hepatocellular carcinoma (HCC), the association between AFP at baseline (b-AFP), subsequent AFP at relapse (r-AFP), and AFP alteration and overall survival in HCC patients receiving locoregional therapy has rarely been systematically elucidated.Patients and MethodsA total of 583 subjects with newly diagnosis of virus-related HCC who were admitted to Beijing You ‘an Hospital, Capital Medical University from January 1, 2012 to December 31, 2016 were prospectively enrolled. The influence of b-AFP, subsequent r-AFP, and AFP alteration on relapse and post-recurrence survival were analyzed.ResultsBy the end of follow-up, a total of 431 (73.9%) patients relapsed and 200 (34.3%) died. Patients with positive b-AFP had a 24% increased risk of recurrence compared with those who were negative. Patients with positive r-AFP had a 68% increased risk of death after relapse compared with those who were negative. The cumulative recurrence-death survival (RDS) rates for 1, 3, 5 years in patients with negative r-AFP were 85.6% (184/215), 70.2%(151/215), and 67.4%(145/215), while the corresponding rates were 75.1% (154/205), 51.2% (105/205), and 48.8% (100/205) in those with positive AFP (P<0.001). 35 (21.6%) of the 162 patients with negative b-AFP turned positive at the time of recurrence, and of this subset, only 12 (34.3%) survived. Of the 255 patients with positive b-AFP, 86 (33.7%) turned negative at the time of relapse, and of this subset, only 30 (34.9%) died. The 1-, 3-, and 5-year cumulative RDS rates were also compared among groups stratified by AFP at baseline and relapse. The present study found that patients with positive AFP at baseline and relapse, as well as those who were negative turned positive, had the shortest RDS and OS.ConclusionsNot only AFP at baseline but also subsequent AFP at relapse can be used to predict a post-recurrence survival, which can help evaluate mortality risk stratification of patients after relapse.

Microwave ablation for painful chest wall metastases from gastrointestinal stromal tumor: a case report

“…As the size of the ablated tumor increased, so did the duration of ablation; additionally, complications became more likely ( 17 ). Multiple ablations may be employed for large or recurrent tumors ( 18 ). Because the tumor in this instance was big and close to the spleen, we chose to ablate a portion of it initially and then undergo another ablation after the tumor shrank.…”

Development and validation of a nomogram to predict the recurrence of hepatocellular carcinoma patients with dynamic changes in AFP undergoing locoregional treatments

“…AFP levels have been proven to correlate with the presence of vascular infiltration and the degree of differentiation ( 30 – 33 ). Moreover, our team’s previous study showed that RFS was shorter in N-P patients who were characterized by multiple tumors, large tumor diameter, and elevated transaminases, representing high liver tumor invasiveness and poor liver function, leading to poor prognosis ( 15 ). Although N-P patients have specific clinicopathological characteristics and prognoses, most prediction models have been developed without considering the specificity of liver biological function in the group of patients and can not reflect an accurate forecast ( 16 ).…”

“…Ablation is the insertion of the electrodes into the tumor issue under the guidance of ultrasound, CT, and MRI, and generates frictional heat by applying high-frequency electrodes to the tissue to damage and destroy HCC cells, resulting in protein denaturation, loss of cell membrane integrity, mitochondrial dysfunction and inhibition of DNA replication (48)(49)(50). Both domestic and international studies and the previous study from our team showed that combination therapy by TACE and ablation improved overall and progression-free survival compared with TACE alone (15,(51)(52)(53)(54). Thus, we used TACE sequential ablation treatment, whose efficacy can be further demonstrated in multiple centers to improve the quality of life and extend the overall survival of more patients with HCC.…”

“…As an essential diagnosis criterion, AFP-negativity can affect the early diagnosis and treatment of patients, thus affecting the prognosis of patients ( 13 , 14 ). Our preliminary research showed that among AFP-NHCC patients, those who turned positive at relapse had a 130% increased risk of death compared with those who remained negative AFP at recurrence ( 15 ). Because of the special clinicopathological features and prognosis of patients with dynamic changes in AFP (N-P, negative at baseline and positive at relapse) ( 16 ), reliable prediction models are needed to guide the clinical treatment of these patients.…”

The Prognostic Value of Alpha-Fetoprotein Ratio in Patients With Resectable Alpha-Fetoprotein-Negative Hepatocellular Carcinoma

“…Another study also demonstrated that AFP-negative HCC patients with a positive AFP level at the time of relapse have a higher mortality rate compared to those with a negative AFP level at relapse. 9 These findings suggest that AFP ratio may serve as a predictive indicator in AFP-negative HCC patients, although its impact on prognosis is still unclear.…”