Tae Seop Lim1, Hyungjin Rhee2, Gyoung Min Kim2, Seung Up Kim3, Beom Kyung Kim3, Jun Yong Park3, Sang Hoon Ahn3, Kwang-Hyub Han3, Jin-Young Choi2, Do Young Kim4. 1. Department of Internal Medicine, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodeamun-gu, Seoul, 120-752, Republic of Korea; Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea; Division of Gastroenterology, Department of Internal Medicine, Mediplex Sejong Hospital, Incheon, Republic of Korea. 2. Department of Radiology, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodeamun-gu, Seoul, 120-752, Republic of Korea. 3. Department of Internal Medicine, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodeamun-gu, Seoul, 120-752, Republic of Korea; Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea. 4. Department of Internal Medicine, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodeamun-gu, Seoul, 120-752, Republic of Korea; Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea. Electronic address: dyk1025@yuhs.ac.
Abstract
PURPOSE: To evaluate the prognostic role of alpha-fetoprotein (AFP), des-gamma-carboxy protein (DCP), and modified Response Evaluation Criteria in Solid Tumors (mRECIST) in patients with hepatocellular carcinoma after transarterial radioembolization (TARE). MATERIALS AND METHODS: During 2009-2016, 63 patients with AFP >20 ng/mL, DCP >20 mAU/mL, and Child-Pugh class A who were treated with TARE were evaluated using landmark and risk-of-death method after TARE. Both resin microspheres (n = 46) and glass microspheres (n = 17) were used. AFP or DCP response was defined as more than 50% decrease from baseline. mRECIST response was defined as complete or partial response. Median age was 60 years, and the proportion of male sex was 77.8% (n = 49). The proportions of patients with Barcelona Clinic Liver Cancer stages A, B, and C were 7.9% (n = 5), 46.0% (n = 29), and 46.0% (n = 29), respectively. RESULTS: At the 3-month landmark, AFP, DCP, and mRECIST responders lived longer than nonresponders (median overall survival, 75.8 vs 7.6 months for AFP; 75.8 vs 7.1 months for DCP; and 75.8 vs 10.0 months for mRECIST; all P < .05). The 6-month risk of death at the 3-month landmark was statistically different only between DCP responders and nonresponders (P = .002). In multivariate analysis, age less than 70 years (P = .024), absence of distant metastasis (P = .049), DCP response (P = .003), and mRECIST response (P = .003) were independent predictors for overall survival at the 3-month landmark after TARE. CONCLUSIONS: AFP, DCP, and mRECIST responders showed better prognosis than nonresponders after TARE, and DCP response was a more potent predictor than AFP response. Tumor marker response, as well as radiologic response, may be useful to predict post-TARE survival.
PURPOSE: To evaluate the prognostic role of alpha-fetoprotein (AFP), des-gamma-carboxy protein (DCP), and modified Response Evaluation Criteria in Solid Tumors (mRECIST) in patients with hepatocellular carcinoma after transarterial radioembolization (TARE). MATERIALS AND METHODS: During 2009-2016, 63 patients with AFP >20 ng/mL, DCP >20 mAU/mL, and Child-Pugh class A who were treated with TARE were evaluated using landmark and risk-of-death method after TARE. Both resin microspheres (n = 46) and glass microspheres (n = 17) were used. AFP or DCP response was defined as more than 50% decrease from baseline. mRECIST response was defined as complete or partial response. Median age was 60 years, and the proportion of male sex was 77.8% (n = 49). The proportions of patients with Barcelona Clinic Liver Cancer stages A, B, and C were 7.9% (n = 5), 46.0% (n = 29), and 46.0% (n = 29), respectively. RESULTS: At the 3-month landmark, AFP, DCP, and mRECIST responders lived longer than nonresponders (median overall survival, 75.8 vs 7.6 months for AFP; 75.8 vs 7.1 months for DCP; and 75.8 vs 10.0 months for mRECIST; all P < .05). The 6-month risk of death at the 3-month landmark was statistically different only between DCP responders and nonresponders (P = .002). In multivariate analysis, age less than 70 years (P = .024), absence of distant metastasis (P = .049), DCP response (P = .003), and mRECIST response (P = .003) were independent predictors for overall survival at the 3-month landmark after TARE. CONCLUSIONS:AFP, DCP, and mRECIST responders showed better prognosis than nonresponders after TARE, and DCP response was a more potent predictor than AFP response. Tumor marker response, as well as radiologic response, may be useful to predict post-TARE survival.
Authors: Dong Hyun Sinn; Seung Up Kim; Hye Kyung Hyun; Eun Ju Cho; Soo Young Park; Young Mi Hong; Soon Sun Kim; Hwi Young Kim; Nae-Yun Heo; Jung Gil Park; Wonseok Kang; Song Won Jeong; Myeong Jun Song; Hana Park; Danbi Lee; Yong Sun Lee; Sung Bum Cho; Chan Sik An; Hyung Jin Rhee; Hyun Woong Lee; Beom Kyung Kim; Jun Yong Park; Do Young Kim; Sang Hoon Ahn; Kwang-Hyub Han; Jeong-Hoon Lee; Su Jong Yu; Yoon Jun Kim; Jung-Hwan Yoon; Won Young Tak; Young Oh Kweon; Ki Tae Yoon; Mong Cho; Jae Youn Cheong; Seung Ha Park Journal: Dig Dis Sci Date: 2020-08-28 Impact factor: 3.199