Z Gastroenterol 2017; 55(08): e57-e299
DOI: 10.1055/s-0037-1605009
Kurzvorträge
Leber und Galle
HCC: Risikostratifizierung, Therapie und Überleben: Donnerstag, 14 September 2017, 11:10 – 12:22, St. Petersburg/Forschungsforum 1
Georg Thieme Verlag KG Stuttgart · New York

Pre-treatment alpha-fetoprotein slope is an independent prognostic factor for overall survival in patients with hepatocellular carcinoma

C Czauderna
1   Universitätsmedizin Mainz, I.Medizinische Klinik und Poliklinik, Mainz, Deutschland
,
S Koch
1   Universitätsmedizin Mainz, I.Medizinische Klinik und Poliklinik, Mainz, Deutschland
,
L Pilz
1   Universitätsmedizin Mainz, I.Medizinische Klinik und Poliklinik, Mainz, Deutschland
,
S Franck
1   Universitätsmedizin Mainz, I.Medizinische Klinik und Poliklinik, Mainz, Deutschland
,
MA Wörns
1   Universitätsmedizin Mainz, I.Medizinische Klinik und Poliklinik, Mainz, Deutschland
,
H Lang
2   Universitätsmedizin Mainz, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Mainz, Deutschland
,
R Kloeckner
3   Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Mainz, Deutschland
,
PR Galle
1   Universitätsmedizin Mainz, I.Medizinische Klinik und Poliklinik, Mainz, Deutschland
,
JU Marquardt
1   Universitätsmedizin Mainz, I.Medizinische Klinik und Poliklinik, Mainz, Deutschland
,
A Weinmann
1   Universitätsmedizin Mainz, I.Medizinische Klinik und Poliklinik, Mainz, Deutschland
› Author Affiliations
Further Information

Publication History

Publication Date:
02 August 2017 (online)

Also available at
 

Background:

Hepatocellular Carcinoma (HCC) is a leading cause of death in cirrhotic patients and ranks among the most lethal cancers worldwide. Novel biomarkers for early detection and accurate prediction of prognosis are urgently needed to improve patient management. Alpha-fetoprotein (AFP) is a well-established and widely used biomarker for HCC. However, diagnostic accuracy of 'static' AFP-values is limited and clinical potential as a prognostic and/or predictive marker needs to be more precisely defined. Therefore, we evaluated the prognostic impact of pre-treatment serum AFP dynamics on the overall survival (OS) of HCC-patients in a German cohort.

Methods:

We retrospectively analyzed patients with confirmed HCC (n = 946) treated at the University Medical Center of the Johannes Gutenberg-University Mainz between 1998 and 2014. Baseline parameters concerning patient status, tumor size and liver function, as well as pre-treatment static and dynamic AFP were investigated. AFP-slope was defined as the delta of two pre-treatment measurements normalized to daily increment/decline. Prognostic impact was assessed using Kaplan-Meier analyses as well as by univariate and multivariate cox regression models.

Results:

Kaplan-Meier analyses showed a poor prognosis for both high single AFP value, assessed at date of diagnosis, as well as high pre-treatment AFP-slope. However, in univariate cox regression analyses, single AFP-value failed to show a prognostic impact (p = 0.7), while pre-treatment AFP-slope showed a strong association to OS (p = 1.7e-03). Several known other clinical parameters such as the BCLC stage (p = 9.7e-04), portal vein thrombosis (PVT) (p = 4.95e-09), extrahepatic spread (p = 2.6e-0), performance status (PST) (9.7e-03), and tumor size (p = 1.7e-03) were also associated with OS. Besides BCLC C (p = 2.06e-08), PVT (p = 6.27e-09), extrahepatic spread (p = 2.6e-03), PST-4 (p = 3.14e-13) and tumor size (P03.14e-13), pre-treatment AFP-slope (p = 1.11e-05) could be confirmed as an independent factor on OS of HCC-patients in multivariate analyses.

Conclusion:

The addition of AFP-slope to established prognostic parameters might improve prognostic classification of HCC. Its impact as a predictive tool for treatment selection will be further investigated.