• Jae Seung Lee, Young Eun Chon, Beom Kyung Kim, Jun Yong Park, Kim Do Young DY https://orcid.org/0000-0002-8327-3439 Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. , Sang Hoon Ahn, Kwang Hyub Han, Wonseok Kang, Moon Seok Choi, Geum Youn Gwak, Yong Han Paik, Joon Hyeok Lee, Kwang Cheol Koh, Paik Seung Woon SW https://orcid.org/0000-0002-6746-6652 Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, S, Hwi Young Kim, Tae Hun Kim, Kwon Yoo, Yeonjung Ha, Mi Na Kim, Joo Ho Lee, Seong Gyu Hwang, Soon Sun Kim, Hyo Jung Cho, Jae Youn Cheong, Sung Won Cho, Seung Ha Park, Nae Yun Heo, Young Mi Hong, Ki Tae Yoon, Mong Cho, Jung Gil Park, Min Kyu Kang, Soo Young Park, Young Oh Kweon, Won Young Tak, Se Young Jang, Dong Hyun Sinn, Seung Up Kim, and Korean TACE Study Group.
• Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
• Yonsei Med. J. 2021 Jan 1; 62 (1): 12-20.

PurposeAlpha-fetoprotein (AFP) is a prognostic marker for hepatocellular carcinoma (HCC). We investigated the prognostic value of AFP levels in patients who achieved complete response (CR) to transarterial chemoembolization (TACE) for HCC.Materials And MethodsBetween 2005 and 2018, 890 patients with HCC who achieved a CR to TACE were recruited. An AFP responder was defined as a patient who showed elevated levels of AFP (>10 ng/mL) during TACE, but showed normalization or a >50% reduction in AFP levels after achieving a CR.ResultsAmong the recruited patients, 569 (63.9%) with naïve HCC and 321 (36.1%) with recurrent HCC after complete resection were treated. Before TACE, 305 (34.3%) patients had multiple tumors, 219 (24.6%) had a maximal tumor size >3 cm, and 22 (2.5%) had portal vein tumor thrombosis. The median AFP level after achieving a CR was 6.36 ng/mL. After a CR, 473 (53.1%) patients experienced recurrence, and 417 (46.9%) died [median progression-free survival (PFS) and overall survival (OS) of 16.3 and 62.8 months, respectively]. High AFP levels at CR (>20 ng/mL) were independently associated with a shorter PFS [hazard ratio (HR)=1.403] and OS (HR=1.284), together with tumor multiplicity at TACE (HR=1.518 and 1.666, respectively). AFP non-responders at CR (76.2%, n=359 of 471) showed a shorter PFS (median 10.5 months vs. 15.5 months, HR=1.375) and OS (median 41.4 months vs. 61.8 months, HR=1.424) than AFP responders (all p=0.001).ConclusionHigh AFP levels and AFP non-responders were independently associated with poor outcomes after TACE. AFP holds clinical implications for detailed risk stratification upon achieving a CR after TACE.© Copyright: Yonsei University College of Medicine 2021.

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