Prognostic Values of Alpha-Fetoprotein and Des-Gamma-Carboxyprothrombin in Hepatocellular Carcinoma in China: An Analysis of 4792 Patients

Abstract

Yang-Xun Pan,1– 3,* Xu-Qi Sun,1,2,* Zi-Li Hu,1,2,* Wa Xie,1,2 Ke-Xin Nie,4 Ai-Ping Fang,5 Ying-Yao Zhang,4 Yi-Zhen Fu,1,2 Jin-Bin Chen,1,2 Jun-Cheng Wang,1,2 Xin Wang,1,2 Yao-Jun Zhang,1,2 Dan-Dan Hu,1,2 Min-Shan Chen1,2 1Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, 510060, People’s Republic of China; 2Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, 510060, People’s Republic of China; 3Department of Oncology-Pathology, Karolinska Institutet, Solna, 17165, Sweden; 4Real World Study Team, BaseBit.ai, Shanghai, 200050, People’s Republic of China; 5Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, People’s Republic of China*These authors contributed equally to this workCorrespondence: Dan-Dan Hu; Min-Shan ChenDepartment of Liver Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People’s Republic of ChinaTel [phone]; [phone]Fax [phone]Email [email protected]; [email protected]: The importance of alpha-fetoprotein (AFP) and des-gamma-carboxyprothrombin (DCP) in hepatocellular carcinoma (HCC) has been studied extensively in Japan, where hepatitis C virus is the predominant aetiology of HCC. The clinical profiles of HCC regarding the state of AFP and DCP in a hepatitis B virus epidemic area have not been comprehensively investigated, and the value of these tumour markers in evaluating the response to treatment and the detection of recurrence has yet to be determined.Patients and Methods: A total of 4792 patients treated in our centre were continuously analysed regarding accessible AFP and DCP data pre- and posttreatment. Baseline characteristics were summarized, and comparisons of progression-free survival (PFS) and overall survival (OS) rates were made independently. The prognostic significance of each factor was tested with the Cox proportional hazards model. Patients who had AFP and DCP data pretreatment, pre- and posttreatment, and those who were continuously monitored more than twice were analysed separately.Results: A total of 2600 patients (53.4%) were positive for AFP and DCP; 362 (7.6%) and 1211 (25.3%) patients were AFP- or DCP-positive, respectively, and 619 patients (12.9%) were negative for both AFP and DCP. Patients in the AFP single-positive or double-negative groups had the best OS (P< 0.001). Patients with less than 50% responses in AFP and DCP after treatments suffered from worse prognostic survival (P< 0.001). In the multivariate analysis, elevated AFP and DCP were identified as independent prognostic factors of PFS and OS. In addition, different tumour markers were related to different clinical and pathological traits.Conclusion: The present study comprehensively explored the clinical value of classical tumour markers for HCC using the “point-to-line” method. Positivity of pretreatment AFP and DCP or less than 50% treatment response rates exhibited more aggressive HCC, resulting in poor PFS and OS in HCC patients.Keywords: alpha-fetoprotein, des-gamma-carboxy prothrombin, hepatocellular carcinoma, clinical features

Keywords

• alpha-fetoprotein
• des-gamma-carboxy prothrombin
• hepatocellular carcinoma
• clinical features