Alpha-Fetoprotein, Des-Gamma-Carboxy Prothrombin, and Modified RECIST Response as Predictors of Survival after Transarterial Radioembolization for Hepatocellular Carcinoma

Tae Seop Lim, Hyungjin Rhee, Gyoung Min Kim, Seung Up Kim, Beom Kyung Kim, Jun Yong Park, Sang Hoon Ahn, Kwang Hyub Han, Jin Young Choi, Do Young Kim

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Purpose: To evaluate the prognostic role of alpha-fetoprotein (AFP), des-gamma-carboxy protein (DCP), and modified Response Evaluation Criteria in Solid Tumors (mRECIST) in patients with hepatocellular carcinoma after transarterial radioembolization (TARE). Materials and Methods: During 2009–2016, 63 patients with AFP >20 ng/mL, DCP >20 mAU/mL, and Child-Pugh class A who were treated with TARE were evaluated using landmark and risk-of-death method after TARE. Both resin microspheres (n = 46) and glass microspheres (n = 17) were used. AFP or DCP response was defined as more than 50% decrease from baseline. mRECIST response was defined as complete or partial response. Median age was 60 years, and the proportion of male sex was 77.8% (n = 49). The proportions of patients with Barcelona Clinic Liver Cancer stages A, B, and C were 7.9% (n = 5), 46.0% (n = 29), and 46.0% (n = 29), respectively. Results: At the 3-month landmark, AFP, DCP, and mRECIST responders lived longer than nonresponders (median overall survival, 75.8 vs 7.6 months for AFP; 75.8 vs 7.1 months for DCP; and 75.8 vs 10.0 months for mRECIST; all P <.05). The 6-month risk of death at the 3-month landmark was statistically different only between DCP responders and nonresponders (P =.002). In multivariate analysis, age less than 70 years (P =.024), absence of distant metastasis (P =.049), DCP response (P =.003), and mRECIST response (P =.003) were independent predictors for overall survival at the 3-month landmark after TARE. Conclusions: AFP, DCP, and mRECIST responders showed better prognosis than nonresponders after TARE, and DCP response was a more potent predictor than AFP response. Tumor marker response, as well as radiologic response, may be useful to predict post-TARE survival.

Original languageEnglish
Pages (from-to)1194-1200.e1
JournalJournal of Vascular and Interventional Radiology
Issue number8
Publication statusPublished - 2019 Aug


All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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