Prognostic value of pretreatment levels of tumor markers for hepatocellular carcinoma on survival after curative treatment of patients with HCC☆

Background/Aims

We evaluated the prognostic value of the pretreatment elevation of tumor markers for hepatocellular carcinoma (HCC) in patients who underwent curative treatment.

Methods

We studied 801 patients who had been diagnosed as initial HCC and fulfilled the following criteria: maximum tumor size, ⩽3cm; number of tumors, ⩽3; remnant liver function, Child-Pugh class A or B; treated by hepatectomy or locoregional thermal ablation (LTA); and alpha-fetoprotein (AFP), Lens culinaris agglutinin A-reactive fraction of AFP (AFP-L3), and des-gamma carboxy prothrombin (DCP) were measured at diagnosis. We analyzed the effects of elevated tumor markers on patient survival in these 2 distinct groups with different types of treatment, i.e. hepatectomy and LTA.

Results

By multivariate analysis in 345 patients who underwent hepatectomy, no tumor marker significantly affected decreased survival rate. In the 456 patients who underwent LTA, the elevation of AFP-L3 (p=0.0171) and DCP (p=0.0004) significantly affected decreased survival rate; DCP elevation had the strongest effect on patient survival.

Conclusions

The prognostic value of pretreatment tumor marker elevation was different in patients who underwent the curative treatment according to the type of treatment. Pretreatment elevation of AFP-L3 and DCP had prognostic values only in patients treated with LTA.

Abbreviations: AFP, alpha-fetoprotein, AFP-L3, Lens-culinaris agglutinin A-reactive fraction of AFP, CT, computed tomography, DCP, des-gamma-carboxy prothrombin, HBV, hepatitis B virus, HCC, hepatocellular carcinoma, HCV, hepatitis C virus, LTA, locoregional thermal ablation, PIVKA-II, protein induced by vitamin K absence-II, PMCT, percutaneous microwave thermocoagulation, RFA, radiofrequency ablation

Keywords: Hepatocellular carcinoma, Tumor markers, Survival, Recurrence, Curative treatment