Propensity Score Matching Analysis of Changes in Alpha-Fetoprotein Levels after Combined Radiotherapy and Transarterial Chemoembolization for Hepatocellular Carcinoma with Portal Vein Tumor Thrombus.

Yuri Jeong,Kang Mo Kim,Seungbong Han,So Yeon Kim,Sang Min Yoon,Han Chu Lee,Jin-Hong Park,Seung Do Ahn,Young-Suk Lim,Sang-Wook Lee,Eun Kyung Choi,Ju Hyun Shim,Jong Hoon Kim,Erica Villa

doi:10.1371/journal.pone.0135298

Yuri Jeong, Kang Mo Kim + Show 12 more

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https://doi.org/10.1371/journal.pone.0135298

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Journal: PloS one	Publication Date: Aug 7, 2015
Citations: 8	License type: CC BY 4.0

Affiliation: University of Ulsan, Asan Medical Center, Ulsan College

Abstract

Background and AimTo investigate the value of changes in alpha-fetoprotein (AFP) levels for the prediction of radiologic response and survival outcomes in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) who received combined treatment of 3-dimensional conformal radiotherapy (3D-CRT) and transarterial chemoembolization (TACE).MethodsA database of 154 HCC patients with PVTT and elevated AFP levels (>20 ng/mL) treated with 3D-CRT and TACE as an initial treatment between August 2002 and August 2008 was retrospectively reviewed. AFP levels were determined 1 month after radiotherapy, and AFP response was defined as an AFP level reduction of >20% from the initial level. Radiologic response, overall survival (OS), and progression-free survival (PFS) rates were compared between AFP responders and non-responders. Propensity-score based matching analysis was performed to minimize the effect of potential confounding bias.ResultsThe median follow-up period was 11.1 months (range, 3.1–82.7 months). In the propensity-score matching cohort (92 pairs), a best radiologic response of CR or PR occurred in more AFP responders than AFP non-responders (41.3% vs. 10.9%, p < 0.001). OS and PFS were also longer in AFP responders than in non-responders (median OS 13.2 months vs. 5.6 months, p < 0.001; median PFS 8.7 months vs. 3.5 months, p < 0.001).ConclusionsAFP response is a significant predictive factor for radiologic response. Furthermore, AFP response is significant for OS and PFS outcomes. AFP evaluation after combined radiotherapy and TACE appears to be a useful predictor of clinical outcomes in HCC patients with PVTT.

Highlights

Despite surveillance programs for hepatocellular carcinoma (HCC) in high-risk populations, most patients are diagnosed with advanced HCC with vascular invasions, and are not eligible for curative treatment
Radiologic response, overall survival (OS), and progression-free survival (PFS) rates were compared between AFP responders and non-responders
In the propensityscore matching cohort (92 pairs), a best radiologic response of complete response (CR) or partial response (PR) occurred in more AFP responders than AFP non-responders (41.3% vs. 10.9%, p < 0.001)

Summary

Introduction

Despite surveillance programs for hepatocellular carcinoma (HCC) in high-risk populations, most patients are diagnosed with advanced HCC with vascular invasions, and are not eligible for curative treatment. The Barcelona Clinic Liver Cancer (BCLC) staging and treatment strategy indicates that sorafenib is the only recommended treatment for advanced stage patients [2], the survival gain is modest and response rates are relatively low [3] Because of these somewhat disappointing results, other various modalities such as transarterial chemoembolization (TACE), radioembolization, hepatic intra-arterial chemotherapy, external beam radiotherapy, and surgical resection in selected cases have been attempted before and after the use of sorafenib. To investigate the value of changes in alpha-fetoprotein (AFP) levels for the prediction of radiologic response and survival outcomes in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) who received combined treatment of 3-dimensional conformal radiotherapy (3D-CRT) and transarterial chemoembolization (TACE)

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