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Prognostic implications of serum alpha-fetoprotein response during treatment of hepatoblastoma
Kyung Nam Koh1, Meerim Park, Bo Eun Kim
1Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Insights
Monitoring alpha-fetoprotein (AFP) levels during hepatoblastoma (HB) treatment helps predict outcomes. High AFP levels and poor response to chemotherapy indicate treatment failure, suggesting alternative therapies like liver transplantation for poor responders.
Area of Science:
- Pediatric Oncology
- Hepatobiliary Malignancies
Background:
- Hepatoblastoma (HB) is a rare liver cancer primarily affecting children.
- Prognostic factors for HB treatment outcomes require further elucidation.
Purpose of the Study:
- To evaluate treatment outcomes in children with hepatoblastoma (HB).
- To identify prognostic factors, particularly serum alpha-fetoprotein (AFP) levels and their changes during treatment, for HB.
Main Methods:
- Retrospective analysis of medical records from 43 children with HB treated between 1991 and 2010.
- Evaluation of serum AFP levels at diagnosis, during chemotherapy, and postoperatively.
Main Results:
- Five-year overall and disease-free survival rates were 62.1% and 65.6%, respectively.
- High diagnostic AFP (>263,000 ng/mL), minimal AFP decline after chemotherapy, and high preoperative/postoperative AFP levels were associated with treatment failure.
- Younger age, thrombocytosis, and early PRETEXT stage correlated with better survival.
Conclusions:
- Serial AFP monitoring, especially perioperative changes, can identify responders and non-responders to chemotherapy.
- Liver transplantation should be considered for patients with poor response to chemotherapy.
Background:
We evaluated the outcomes and prognostic factors, especially serum levels of alpha-fetoprotein (AFP) and their changes during the treatment of hepatoblastoma (HB).
Procedure:
We retrospectively analyzed the medical records of 43 consecutive children with HB treated at a single institution between 1991 and 2010.
Results:
Of 43 patients, 5 (12%) underwent primary tumor resection at diagnosis and 38 (88%) received preoperative chemotherapy. Of those 38 patients, 7 (16%) died of progressive disease during preoperative chemotherapy, and 31 (72%) underwent curative operations, including 5 who underwent liver transplantation, after a median 4 cycles of chemotherapy (range, 3-14 cycles). The 5-year overall survival and disease-free survival rates were 62.1 ± 8.3% and 65.6 ± 7.6%, respectively. AFP >263,000 ng/mL at diagnosis, a decline of <1 log in AFP levels after the first cycle of chemotherapy, preoperative AFP levels in the highest tertile, and postoperative AFP levels in the highest tertiles were significantly associated with treatment failure. Age younger than 1 year at diagnosis, thrombocytosis at diagnosis, and early PRETEXT (pretreatment extent of disease) stage were significantly associated with better survival outcomes, whereas gender and metastasis were not. Multivariate analysis showed that high level of preoperative AFP was an independent predictor of treatment failure.
Conclusions:
Serial monitoring of changes in AFP levels during the treatment, especially perioperative changes, may help identify favorable and poor responders to chemotherapy. Alternative treatment, such as liver transplantation, should be considered for poor responders.
