Serum alpha-fetoprotein response as a preoperative prognostic indicator in unresectable hepatocellular carcinoma with salvage hepatectomy following conversion therapy: a multicenter retrospective study

作者：Kongying Lin, Jianxi Zhang, Zhi-Wen Lin, Qing-Jing Chen, Liuping Luo, Jinhong Chen, Kui Wang, Sheng Tai, Zhi‐Bo Zhang, Shifeng Wang, Jingdong Li, Kai Wang, Lu Zheng, Si-Ming Zheng, Mengmeng Wu, Kecan Lin, Tian Yang, Yongyi Zeng · 发表于：Frontiers in Immunology · 年份：2024 · DOI：10.3389/fimmu.2024.1308543 · 被引用次数：5 · 研究领域：Hepatocellular Carcinoma Treatment and Prognosis、Liver Disease Diagnosis and Treatment、Ovarian cancer diagnosis and treatment

Background This study evaluates the efficacy of alpha-fetoprotein (AFP) response as a surrogate marker for determining recurrence-free survival (RFS) in patients with unresectable hepatocellular carcinoma (uHCC) who undergo salvage hepatectomy following conversion therapy with tyrosine kinase inhibitor (TKI) and anti-PD-1 antibody-based regimen. Methods This multicenter retrospective study included 74 patients with uHCC and positive AFP (>20 ng/mL) at diagnosis, who underwent salvage hepatectomy after treatment with TKIs and anti-PD-1 antibody-based regimens. The association between AFP response—defined as a ≥ 80% decrease in final AFP levels before salvage hepatectomy from diagnosis—and RFS post-hepatectomy was investigated. Results AFP responders demonstrated significantly better postoperative RFS compared to non-responders ( P <0.001). The median RFS was not reached for AFP responders, with 1-year and 2-year RFS rates of 81.3% and 70.8%, respectively. In contrast, AFP non-responders had a median RFS of 7.43 months, with 1-year and 2-year RFS rates at 37.1% and 37.1%, respectively. Multivariate Cox regression analysis identified AFP response as an independent predictor of RFS. Integrating AFP response with radiologic tumor response facilitated further stratification of patients into distinct risk categories: those with radiologic remission experienced the most favorable RFS, followed by patients with partial response/stable disease and AFP response, and the le...