Early α-fetoprotein response as a predictor for clinical outcome after localized concurrent chemoradiotherapy for advanced hepatocellular carcinoma

Backgrounds There are limitations in using only radiological criteria to evaluate treatment outcomes in hepatocellular carcinoma (HCC). alpha-fetoprotein (AFP) is regarded as an indicator of tumour activity in HCC. Aims We present a novel correlation between AFP response and survival outcome in patients treated with localized concurrent chemoradiotherapy (CCRT). Materials From 2005 to 2008, 187 locally advanced HCC patients underwent localized CCRT (external beam radiotherapy at 45 Gy over 5 weeks plus a concurrent hepatic arterial infusion of 5-fluorouracil during the first/fifth week), followed by repetitive hepatic arterial infusional chemotherapy (HAIC) with 5-fluorouracil and cisplatin. Among them, 149 with an elevated baseline AFP level (> 20 ng/ml) were finally studied. AFP response was defined as > 50% decrease from baseline, 1 month after the completion of localized CCRT. Results Patients' characteristics were as follows: median age (52 years); Child-Pugh class A/B (n=137/12 respectively); and portal vein thrombosis (n=118). AFP responders (101 patients) had better objective responses than AFP non-responders (48 patients) after CCRT (44.5 vs. 12.5%; P < 0.001) and subsequent HAIC (51.5 vs. 16.7%; P < 0.001). Both median progression-free survival (PFS, 8.1 vs. 3.9 months; P < 0.001) and overall survival (OS, 13.3 vs. 5.9 months; P < 0.001) were longer in AFP responders than AFP non-responders. In multivariate analysis, AFP response and objective response were independent factors affecting PFS and OS. Furthermore, AFP non-responders were more likely to have extrahepatic metastasis within 6 months of treatments initiation than AFP responders (59.5 vs. 25.9%; P < 0.001). Conclusions Early AFP response may be useful not only in predicting prognosis and treatment response but also in establishing optimized treatment plans for HCC.