The Alpha-fetoprotein Response Predicts The Survival Of Advanced Hepatocellular Carcinoma Patients Treated With Sorafenib Combined With Transarterial Chemoembolization

Background/Aims: Sorafenib combined with transarterial chemoembolization (TACE) isconsidered a safe and effective treatment for advanced hepatocellular carcinoma (HCC).The prognostic value of alpha-fetoprotein (AFP) response has been confirmed in othertreatments. This study aimed to evaluate whether the alpha-fetoprotein (AFP) response canpredict the survival of patients treated with this combination therapy.Methods: From May2008to July2012,118patients with advanced HCC and a baselineAFP level≥20ng/ml were treated with the combination therapy. AFP levels at baselineand1-2months after initiation of the combination therapy were recorded. A receiveroperating characteristics (ROC) curve was used to generate a cutoff point for AFP changesfor predicting survival. Cox regression analysis was used to evaluate the relationship between AFP response and survival.Results: For the ROC curve, an AFP level reduction of46%was identified as the cutoffpoint. The median overall survival (OS) was significantly longer in AFP response groupthan in non-response group (14.8months vs.6.4months, P<0.0001). In a multivariateanalysis, AFP response was an independent predictor of OS. For84patients withradiological evaluation, AFP response was significantly associated with modifiedResponse Evaluation Criteria in Solid Tumors (mRECIST) criteria response (P=0.002),but not RECIST criteria response (P=0.606). For34patients without radiologicalevaluation, AFP response group had a longer median OS than AFP non-response group(37.1months vs.3.7months, P=0.001).Conclusion: AFP response could predict the survival of patients with advanced HCCtreated with Sorafenib combined with TACE, even in the absence of radiologicalevaluation.