Open AccessHigh pretreatment static and dynamic alpha‐fetoprotein values predict reduced overall survival in hepatocellular carcinoma
Author(s) -
Czauderna Carolin,
Schmidtmann Irene,
Koch Sandra,
Pilz Lukas,
Heinrich Sophia,
Otto Gerd,
Mittler Jens,
Lang Hauke,
Kloeckner Roman,
Düber Christoph,
Sprinzl Martin F.,
Worns Marcus A.,
Galle Peter R.,
Marquardt Jens U.,
Weinmann Arndt
Publication year - 2021
Publication title -
ueg journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 35
eISSN - 2050-6414
pISSN - 2050-6406
DOI - 10.1177/2050640620972611
Subject(s) - hepatocellular carcinoma , medicine , proportional hazards model , alpha fetoprotein , biomarker , oncology , gastroenterology , cohort , carcinoma , survival analysis , stage (stratigraphy) , overall survival , paleontology , biochemistry , chemistry , biology
Abstract Background Hepatocellular carcinoma is one of the most lethal cancers worldwide. Novel prognostic and/or predictive biomarkers are urgently needed to improve patient management. Alpha‐fetoprotein (AFP) is a well‐established and widely used biomarker for hepatocellular carcinoma. However, diagnostic accuracy of static AFP values is limited and the clinical potential is a matter of ongoing scientific discussion. Objective We here evaluated the prognostic impact of pretreatment static and dynamic AFP variables on overall survival of hepatocellular carcinoma patients in a Western cohort. Methods Patients with confirmed hepatocellular carcinoma ( n = 809) treated at the Johannes Gutenberg University Mainz between 1998 and 2014 and two available pretreatment AFP‐values (AFP‐slope) were retrospectively analysed. Clinicopathological baseline parameters, pretreatment static values and AFP‐slope were assessed. Prognostic impact was determined by Kaplan–Meier analyses and Cox regression models. Results High static and dynamic AFP variables prior to therapy were associated with reduced survival rates of hepatocellular carcinoma patients. Several known clinical parameters such as Child–Pugh B (p < 0.01) and C stage ( p < 0.001), portal vein thrombosis ( p < 0.001) and extrahepatic spread ( p < 0.001) were confirmed as independent predictors for overall survival. Addition of static and/or dynamic AFP variable resulted in higher time‐dependent area under the curves. Notably, in patients with more favourable prognosis, AFP‐slope prior to therapy was a slightly stronger predictor for overall survival compared with static AFP values. Conclusion Static and dynamic AFP variables prior to therapy are predictive for overall survival of hepatocellular carcinoma patients. Addition of AFP‐slope to established prognostic parameters might improve prognostic classification for a subgroup of hepatocellular carcinoma patients with preserved liver function and without portal vein tumour thrombosis.