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Title: Prognostic role of alpha-fetoprotein in patients with hepatocellular carcinoma treated with repeat transarterial chemoembolisation.
Austin Authors: Mishra, Gauri;Dev, Anouk;Paul, Eldho;Cheung, Wa;Koukounaras, Jim;Jhamb, Ashu;Marginson, Ben;Lim, Beng Ghee;Simkin, Paul;Borsaru, Adina;Burnes, James;Goodwin, Mark D ;Ramachandra, Vivek;Spanger, Manfred;Lubel, John;Gow, Paul J ;Sood, Siddharth ;Thompson, Alexander;Ryan, Marno;Nicoll, Amanda;Bell, Sally;Majeed, Ammar;Kemp, William;Roberts, Stuart K
Affiliation: School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
Gastroenterology, St. Vincent's Hospital, Melbourne, Australia
Department of Gastroenterology, Austin Health, Heidelberg, Victoria, Australia
Radiology, Eastern Health, Melbourne, Australia
Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
Radiology, Royal Melbourne Hospital, Melbourne, Australia
Radiology, St. Vincent's Hospital, Melbourne, Australia
Radiology, Alfred Health, Melbourne, Australia
Gastroenterology, Eastern Health, Melbourne, Australia
Gastroenterology, Monash Health, Melbourne, Australia
Department of Gastroenterology, The Alfred Hospital, 55 Commercial Rd, Melbourne, 3004, Australia
Gastroenterology, Royal Melbourne Hospital, Melbourne, Australia
Radiology, Monash Health Eastern Health, Melbourne, Australia
Issue Date: 29-May-2020 2020-05-29
Publication information: BMC cancer 2020; 20(1): 483
Abstract: Repeat transarterial chemoembolisation (rTACE) is often required for hepatocellular carcinoma (HCC) to achieve disease control, however, current practice guidelines regarding treatment allocation vary significantly. This study aims to identify key factors associated with patient survival following rTACE to facilitate treatment allocation and prognostic discussion. Patients with HCC undergoing rTACE at six Australian tertiary centers from 2009 to 2014 were included. Variables encompassing clinical, tumour, treatment type and response factors were analysed against the primary outcome of overall survival. Univariate analysis and multivariate Cox regression modelling were used to identify factors pre- and post-TACE therapy significantly associated with survival. Total of 292 consecutive patients underwent rTACE with mainly Child Pugh A cirrhosis (61%) and BCLC stage A (57%) disease. Median overall survival (OS) was 30 months (IQR 15.2-50.2) from initial TACE. On multivariate analysis greater tumour number (p = 0.02), higher serum bilirubin (p = 0.007) post initial TACE, and hepatic decompensation (p = 0.001) post second TACE were associated with reduced survival. Patients with serum AFP ≥ 200 ng/ml following initial TACE had lower survival (p = 0.001), compared to patients with serum AFP level that remained < 200 ng/ml post-initial TACE, with an overall survival of 19.4 months versus 34.7 months (p = 0.0001) respectively. Serum AFP level following initial treatment in patients undergoing repeat TACE for HCC is a simple and useful clinical prognostic marker. Moreover, it has the potential to facilitate appropriate patient selection for rTACE particularly when used in conjunction with baseline tumour burden and severity of hepatic dysfunction post-initial TACE.
DOI: 10.1186/s12885-020-06806-4
ORCID: 0000-0001-6505-7233
PubMed URL: 32471447
Type: Journal Article
Subjects: Alpha-fetoprotein
Hepatocellular carcinoma
Repeat transarterial chemoembolisation
Appears in Collections:Journal articles

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