Serum alpha-fetoprotein response as a preoperative prognostic indicator in unresectable hepatocellular carcinoma with salvage hepatectomy following conversion therapy: a multicenter retrospective study

Kong-Ying Lin ^1,2, Jian-Xi Zhang ^2,3, Zhi-Wen Lin ^1,2

¹Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China.
²Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
³Department of Hepatobiliary Surgery, Xiamen Hospital, Beijing University of Chinese Medicine, Xiamen, China.
⁴Department of General Surgery, Huashan Hospital, Cancer Metastasis Institute, Fudan University, Shanghai, China.
⁵Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Navy Medical University (Second Military Medical University), Shanghai, China.
⁶Department of Hepatopancreatobiliary Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin, China.
⁷Department of Hepatopancreatobiliary Surgery, Ganzhou Fifth People's Hospital of Gannan Medical University, Ganzhou, China.
⁸Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of North Sichuan Medical College, Sichuan, China.
⁹Department of Hepatopancreatobiliary Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, China.
¹⁰Department of Hepatopancreatobiliary Surgery, Second Affiliated Hospital of Army Medical University, Chongqing, China.
¹¹Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Ningbo University, Ningbo, China.

⁰Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China.

Frontiers in Immunology +

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March 4, 2024

View abstract on PubMed

Summary

Alpha-fetoprotein (AFP) response predicts recurrence-free survival in unresectable hepatocellular carcinoma (uHCC) patients undergoing salvage hepatectomy. The "20-80" rule aids in preoperative risk stratification for better patient management.

Area Of Science

Hepatobiliary Surgery
Medical Oncology
Biomarker Research

Background

Hepatocellular carcinoma (HCC) recurrence remains a challenge after treatment.
Identifying reliable markers for predicting outcomes in unresectable HCC (uHCC) is crucial.
Salvage hepatectomy following conversion therapy offers a potential curative option for selected uHCC patients.

Purpose Of The Study

To evaluate alpha-fetoprotein (AFP) response as a surrogate marker for recurrence-free survival (RFS).
To assess the efficacy of AFP response in patients with uHCC undergoing salvage hepatectomy after tyrosine kinase inhibitor (TKI) and anti-PD-1 antibody therapy.
To establish a predictive rule for preoperative risk stratification.

Main Methods

Multicenter retrospective study of 74 patients with uHCC and elevated AFP (>20 ng/mL).
Patients received conversion therapy with TKIs and anti-PD-1 antibodies before salvage hepatectomy.
AFP response defined as ≥ 80% decrease in AFP levels pre-hepatectomy; association with RFS analyzed.

Main Results

AFP responders showed significantly better RFS than non-responders (P<0.001).
Median RFS was not reached for responders (1-year: 81.3%, 2-year: 70.8%) vs. 7.43 months for non-responders (1-year: 37.1%, 2-year: 37.1%).
AFP response independently predicted RFS; combined with radiologic response, it stratified patients into distinct risk categories.

Conclusions

The "20-80" rule based on AFP response aids preoperative risk stratification for salvage hepatectomy in uHCC.
This rule helps identify patients unlikely to benefit from salvage hepatectomy, guiding clinical management.
AFP response serves as a valuable surrogate marker for predicting RFS in this patient population.

Keywords:

alpha-fetoprotein response conversion therapy hepatocellular carcinoma recurrence-free survival salvage resection