Serum alpha-fetoprotein response as a preoperative prognostic indicator in unresectable hepatocellular carcinoma with salvage hepatectomy following conversion therapy: a multicenter retrospective study
BackgroundThis study evaluates the efficacy of alpha-fetoprotein (AFP) response as a surrogate marker for determining recurrence-free survival (RFS) in patients with unresectable hepatocellular carcinoma (uHCC) who undergo salvage hepatectomy following conversion therapy with tyrosine kinase inhibit...
| Main Authors: | , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2024-02-01
|
| Series: | Frontiers in Immunology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2024.1308543/full |
| _version_ | 1797305254100860928 |
|---|---|
| author | Kong-Ying Lin Kong-Ying Lin Jian-Xi Zhang Jian-Xi Zhang Zhi-Wen Lin Zhi-Wen Lin Qing-Jing Chen Qing-Jing Chen Liu-Ping Luo Jin-Hong Chen Kui Wang Sheng Tai Zhi-Bo Zhang Shi-Feng Wang Jing-Dong Li Kai Wang Lu Zheng Si-Ming Zheng Meng-Meng Wu Ke-Can Lin Tian Yang Yong-Yi Zeng Yong-Yi Zeng |
| author_facet | Kong-Ying Lin Kong-Ying Lin Jian-Xi Zhang Jian-Xi Zhang Zhi-Wen Lin Zhi-Wen Lin Qing-Jing Chen Qing-Jing Chen Liu-Ping Luo Jin-Hong Chen Kui Wang Sheng Tai Zhi-Bo Zhang Shi-Feng Wang Jing-Dong Li Kai Wang Lu Zheng Si-Ming Zheng Meng-Meng Wu Ke-Can Lin Tian Yang Yong-Yi Zeng Yong-Yi Zeng |
| author_sort | Kong-Ying Lin |
| collection | DOAJ |
| description | BackgroundThis study evaluates the efficacy of alpha-fetoprotein (AFP) response as a surrogate marker for determining recurrence-free survival (RFS) in patients with unresectable hepatocellular carcinoma (uHCC) who undergo salvage hepatectomy following conversion therapy with tyrosine kinase inhibitor (TKI) and anti-PD-1 antibody-based regimen.MethodsThis multicenter retrospective study included 74 patients with uHCC and positive AFP (>20 ng/mL) at diagnosis, who underwent salvage hepatectomy after treatment with TKIs and anti-PD-1 antibody-based regimens. The association between AFP response—defined as a ≥ 80% decrease in final AFP levels before salvage hepatectomy from diagnosis—and RFS post-hepatectomy was investigated.ResultsAFP responders demonstrated significantly better postoperative RFS compared to non-responders (P<0.001). The median RFS was not reached for AFP responders, with 1-year and 2-year RFS rates of 81.3% and 70.8%, respectively. In contrast, AFP non-responders had a median RFS of 7.43 months, with 1-year and 2-year RFS rates at 37.1% and 37.1%, respectively. Multivariate Cox regression analysis identified AFP response as an independent predictor of RFS. Integrating AFP response with radiologic tumor response facilitated further stratification of patients into distinct risk categories: those with radiologic remission experienced the most favorable RFS, followed by patients with partial response/stable disease and AFP response, and the least favorable RFS among patients with partial response/stable disease but without AFP response. Sensitivity analyses further confirmed the association between AFP response and improved RFS across various cutoff values and in patients with AFP ≥ 200 ng/mL at diagnosis (all P<0.05).ConclusionThe “20-80” rule based on AFP response could be helpful for clinicians to preoperatively stratify the risk of patients undergoing salvage hepatectomy, enabling identification and management of those unlikely to benefit from this procedure. |
| first_indexed | 2024-03-08T00:23:16Z |
| format | Article |
| id | doaj.art-c94467943cf8482793fef503755d11c9 |
| institution | Directory Open Access Journal |
| issn | 1664-3224 |
| language | English |
| last_indexed | 2024-03-08T00:23:16Z |
| publishDate | 2024-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Immunology |
| spelling | doaj.art-c94467943cf8482793fef503755d11c92024-02-16T04:29:46ZengFrontiers Media S.A.Frontiers in Immunology1664-32242024-02-011510.3389/fimmu.2024.13085431308543Serum alpha-fetoprotein response as a preoperative prognostic indicator in unresectable hepatocellular carcinoma with salvage hepatectomy following conversion therapy: a multicenter retrospective studyKong-Ying Lin0Kong-Ying Lin1Jian-Xi Zhang2Jian-Xi Zhang3Zhi-Wen Lin4Zhi-Wen Lin5Qing-Jing Chen6Qing-Jing Chen7Liu-Ping Luo8Jin-Hong Chen9Kui Wang10Sheng Tai11Zhi-Bo Zhang12Shi-Feng Wang13Jing-Dong Li14Kai Wang15Lu Zheng16Si-Ming Zheng17Meng-Meng Wu18Ke-Can Lin19Tian Yang20Yong-Yi Zeng21Yong-Yi Zeng22Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, ChinaDepartment of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, ChinaDepartment of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, ChinaDepartment of Hepatobiliary Surgery, Xiamen Hospital, Beijing University of Chinese Medicine, Xiamen, ChinaDepartment of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, ChinaDepartment of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, ChinaDepartment of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, ChinaDepartment of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, ChinaDepartment of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, ChinaDepartment of General Surgery, Huashan Hospital, Cancer Metastasis Institute, Fudan University, Shanghai, ChinaDepartment of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Navy Medical University (Second Military Medical University), Shanghai, ChinaDepartment of Hepatopancreatobiliary Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin, ChinaDepartment of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, ChinaDepartment of Hepatopancreatobiliary Surgery, Ganzhou Fifth People’s Hospital of Gannan Medical University, Ganzhou, ChinaDepartment of Hepatopancreatobiliary Surgery, The Affiliated Hospital of North Sichuan Medical College, Sichuan, ChinaDepartment of Hepatopancreatobiliary Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, China0Department of Hepatopancreatobiliary Surgery, Second Affiliated Hospital of Army Medical University, Chongqing, China1Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Ningbo University, Ningbo, ChinaDepartment of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, ChinaDepartment of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, ChinaDepartment of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Navy Medical University (Second Military Medical University), Shanghai, ChinaDepartment of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, ChinaDepartment of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, ChinaBackgroundThis study evaluates the efficacy of alpha-fetoprotein (AFP) response as a surrogate marker for determining recurrence-free survival (RFS) in patients with unresectable hepatocellular carcinoma (uHCC) who undergo salvage hepatectomy following conversion therapy with tyrosine kinase inhibitor (TKI) and anti-PD-1 antibody-based regimen.MethodsThis multicenter retrospective study included 74 patients with uHCC and positive AFP (>20 ng/mL) at diagnosis, who underwent salvage hepatectomy after treatment with TKIs and anti-PD-1 antibody-based regimens. The association between AFP response—defined as a ≥ 80% decrease in final AFP levels before salvage hepatectomy from diagnosis—and RFS post-hepatectomy was investigated.ResultsAFP responders demonstrated significantly better postoperative RFS compared to non-responders (P<0.001). The median RFS was not reached for AFP responders, with 1-year and 2-year RFS rates of 81.3% and 70.8%, respectively. In contrast, AFP non-responders had a median RFS of 7.43 months, with 1-year and 2-year RFS rates at 37.1% and 37.1%, respectively. Multivariate Cox regression analysis identified AFP response as an independent predictor of RFS. Integrating AFP response with radiologic tumor response facilitated further stratification of patients into distinct risk categories: those with radiologic remission experienced the most favorable RFS, followed by patients with partial response/stable disease and AFP response, and the least favorable RFS among patients with partial response/stable disease but without AFP response. Sensitivity analyses further confirmed the association between AFP response and improved RFS across various cutoff values and in patients with AFP ≥ 200 ng/mL at diagnosis (all P<0.05).ConclusionThe “20-80” rule based on AFP response could be helpful for clinicians to preoperatively stratify the risk of patients undergoing salvage hepatectomy, enabling identification and management of those unlikely to benefit from this procedure.https://www.frontiersin.org/articles/10.3389/fimmu.2024.1308543/fullhepatocellular carcinomasalvage resectionalpha-fetoprotein responserecurrence-free survivalconversion therapy |
| spellingShingle | Kong-Ying Lin Kong-Ying Lin Jian-Xi Zhang Jian-Xi Zhang Zhi-Wen Lin Zhi-Wen Lin Qing-Jing Chen Qing-Jing Chen Liu-Ping Luo Jin-Hong Chen Kui Wang Sheng Tai Zhi-Bo Zhang Shi-Feng Wang Jing-Dong Li Kai Wang Lu Zheng Si-Ming Zheng Meng-Meng Wu Ke-Can Lin Tian Yang Yong-Yi Zeng Yong-Yi Zeng Serum alpha-fetoprotein response as a preoperative prognostic indicator in unresectable hepatocellular carcinoma with salvage hepatectomy following conversion therapy: a multicenter retrospective study Frontiers in Immunology hepatocellular carcinoma salvage resection alpha-fetoprotein response recurrence-free survival conversion therapy |
| title | Serum alpha-fetoprotein response as a preoperative prognostic indicator in unresectable hepatocellular carcinoma with salvage hepatectomy following conversion therapy: a multicenter retrospective study |
| title_full | Serum alpha-fetoprotein response as a preoperative prognostic indicator in unresectable hepatocellular carcinoma with salvage hepatectomy following conversion therapy: a multicenter retrospective study |
| title_fullStr | Serum alpha-fetoprotein response as a preoperative prognostic indicator in unresectable hepatocellular carcinoma with salvage hepatectomy following conversion therapy: a multicenter retrospective study |
| title_full_unstemmed | Serum alpha-fetoprotein response as a preoperative prognostic indicator in unresectable hepatocellular carcinoma with salvage hepatectomy following conversion therapy: a multicenter retrospective study |
| title_short | Serum alpha-fetoprotein response as a preoperative prognostic indicator in unresectable hepatocellular carcinoma with salvage hepatectomy following conversion therapy: a multicenter retrospective study |
| title_sort | serum alpha fetoprotein response as a preoperative prognostic indicator in unresectable hepatocellular carcinoma with salvage hepatectomy following conversion therapy a multicenter retrospective study |
| topic | hepatocellular carcinoma salvage resection alpha-fetoprotein response recurrence-free survival conversion therapy |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2024.1308543/full |
| work_keys_str_mv | AT kongyinglin serumalphafetoproteinresponseasapreoperativeprognosticindicatorinunresectablehepatocellularcarcinomawithsalvagehepatectomyfollowingconversiontherapyamulticenterretrospectivestudy AT kongyinglin serumalphafetoproteinresponseasapreoperativeprognosticindicatorinunresectablehepatocellularcarcinomawithsalvagehepatectomyfollowingconversiontherapyamulticenterretrospectivestudy AT jianxizhang serumalphafetoproteinresponseasapreoperativeprognosticindicatorinunresectablehepatocellularcarcinomawithsalvagehepatectomyfollowingconversiontherapyamulticenterretrospectivestudy AT jianxizhang serumalphafetoproteinresponseasapreoperativeprognosticindicatorinunresectablehepatocellularcarcinomawithsalvagehepatectomyfollowingconversiontherapyamulticenterretrospectivestudy AT zhiwenlin serumalphafetoproteinresponseasapreoperativeprognosticindicatorinunresectablehepatocellularcarcinomawithsalvagehepatectomyfollowingconversiontherapyamulticenterretrospectivestudy AT zhiwenlin serumalphafetoproteinresponseasapreoperativeprognosticindicatorinunresectablehepatocellularcarcinomawithsalvagehepatectomyfollowingconversiontherapyamulticenterretrospectivestudy AT qingjingchen serumalphafetoproteinresponseasapreoperativeprognosticindicatorinunresectablehepatocellularcarcinomawithsalvagehepatectomyfollowingconversiontherapyamulticenterretrospectivestudy AT qingjingchen serumalphafetoproteinresponseasapreoperativeprognosticindicatorinunresectablehepatocellularcarcinomawithsalvagehepatectomyfollowingconversiontherapyamulticenterretrospectivestudy AT liupingluo serumalphafetoproteinresponseasapreoperativeprognosticindicatorinunresectablehepatocellularcarcinomawithsalvagehepatectomyfollowingconversiontherapyamulticenterretrospectivestudy AT jinhongchen serumalphafetoproteinresponseasapreoperativeprognosticindicatorinunresectablehepatocellularcarcinomawithsalvagehepatectomyfollowingconversiontherapyamulticenterretrospectivestudy AT kuiwang serumalphafetoproteinresponseasapreoperativeprognosticindicatorinunresectablehepatocellularcarcinomawithsalvagehepatectomyfollowingconversiontherapyamulticenterretrospectivestudy AT shengtai serumalphafetoproteinresponseasapreoperativeprognosticindicatorinunresectablehepatocellularcarcinomawithsalvagehepatectomyfollowingconversiontherapyamulticenterretrospectivestudy AT zhibozhang serumalphafetoproteinresponseasapreoperativeprognosticindicatorinunresectablehepatocellularcarcinomawithsalvagehepatectomyfollowingconversiontherapyamulticenterretrospectivestudy AT shifengwang serumalphafetoproteinresponseasapreoperativeprognosticindicatorinunresectablehepatocellularcarcinomawithsalvagehepatectomyfollowingconversiontherapyamulticenterretrospectivestudy AT jingdongli serumalphafetoproteinresponseasapreoperativeprognosticindicatorinunresectablehepatocellularcarcinomawithsalvagehepatectomyfollowingconversiontherapyamulticenterretrospectivestudy AT kaiwang serumalphafetoproteinresponseasapreoperativeprognosticindicatorinunresectablehepatocellularcarcinomawithsalvagehepatectomyfollowingconversiontherapyamulticenterretrospectivestudy AT luzheng serumalphafetoproteinresponseasapreoperativeprognosticindicatorinunresectablehepatocellularcarcinomawithsalvagehepatectomyfollowingconversiontherapyamulticenterretrospectivestudy AT simingzheng serumalphafetoproteinresponseasapreoperativeprognosticindicatorinunresectablehepatocellularcarcinomawithsalvagehepatectomyfollowingconversiontherapyamulticenterretrospectivestudy AT mengmengwu serumalphafetoproteinresponseasapreoperativeprognosticindicatorinunresectablehepatocellularcarcinomawithsalvagehepatectomyfollowingconversiontherapyamulticenterretrospectivestudy AT kecanlin serumalphafetoproteinresponseasapreoperativeprognosticindicatorinunresectablehepatocellularcarcinomawithsalvagehepatectomyfollowingconversiontherapyamulticenterretrospectivestudy AT tianyang serumalphafetoproteinresponseasapreoperativeprognosticindicatorinunresectablehepatocellularcarcinomawithsalvagehepatectomyfollowingconversiontherapyamulticenterretrospectivestudy AT yongyizeng serumalphafetoproteinresponseasapreoperativeprognosticindicatorinunresectablehepatocellularcarcinomawithsalvagehepatectomyfollowingconversiontherapyamulticenterretrospectivestudy AT yongyizeng serumalphafetoproteinresponseasapreoperativeprognosticindicatorinunresectablehepatocellularcarcinomawithsalvagehepatectomyfollowingconversiontherapyamulticenterretrospectivestudy |