Serial alpha-feto protein in predicting radiological response and overall survival of patient with inoperable hepatocellular carcinoma (HCC) during chemotherapy

Abstract

4602 Background: Although alpha-feto protein (AFP) is frequently measured during treatment of hepatocellular carcinoma (HCC), the trend of AFP in predicting response and survival of HCC patients is not clear. Methods: We retrospectively reviewed the serial AFP value in HCC patients who were entered to a phase III randomized clinical trial of doxorubicin versus cisplatin/interferon-α/doxorubicin/fluorouracil (Yeo et al. J Natl Cancer Inst. 2005 19;97) for histologically unresectable HCC. Patients with baseline AFP >100 ng/ml had their serial AFP correlated with response and survival. A significant drop of AFP is defined as a decrease of AFP >20% after the second or third cycle of chemotherapy. The relationship between the trend of AFP and response was examined. Overall survival analysis was performed by using Cox-regression in univariate and multivariate analysis. Results: Total 129 out of 188 patients were eligible for analysis. The Male and Female ratio was 117:12; the median age was 49; 88.8% belonged to ECOG 0. During chemotherapy, 44 patients had significant drop of AFP while 85 did not have. The response rates were 20/44 (45.5%) vs. 4/85 (4.7%) respectively (p<0.0001). Patients with significant drop of AFP had much batter overall survival than those who did not achieve this endpoint (OS: 12.1 vs. 3.8 ms; p <0.0001). Multivariate analysis revealed that post chemo drop of AFP >20% (p<0.0001; hazard ratio=0.36; 95% CI 0.24–0.55) after adjusting the bilirubin and ALT level affected survival significantly. Conclusions: Serial measurement of AFP during chemotherapy is important in monitoring response and outcome for advanced HCC. Dropping of AFP is predictive of radiological response and overall survival. Patients who do not achieve the target drop of AFP >20% after second or third cycle of chemotherapy have poor prognosis. No significant financial relationships to disclose.