Clinical utility of des-γ-carboxyprothrombin kinetics as a complement to radiologic response in patients with hepatocellular carcinoma undergoing transarterial chemoembolization.

Abstract

PURPOSE:

Serial α-fetoprotein (AFP) measurements are useful for assessing tumor responses to numerous therapies for hepatocellular carcinoma (HCC). This study tested the predictive value of changes in des-γ-carboxy prothrombin (DCP), in parallel with AFP, as an indicator of HCC response after transarterial chemoembolization.

MATERIALS AND METHODS:

The study group consisted of 327 patients with HCC initially seropositive for DCP (≥ 40 mAU/mL) and/or AFP (≥ 100 ng/mL) who underwent repeated chemoembolization as first-line therapy. Radiologic responses were measured based on modified Response Evaluation Criteria In Solid Tumors guidelines. Serologic response was defined as a decrease of at least 50% in DCP or AFP level from baseline. Radiologic-serologic correlation and disease progression and survival according to serologic responses were analyzed.

RESULTS:

Before treatment, 129 patients (39%) had high DCP alone, 66 (20%) had high AFP alone, and 58 (18%) had high levels of both. Radiologic and serologic responses were achieved in 88.2% and 91.4% of patients with high DCP levels and in 89.5% and 91.1% of those with high AFP levels, respectively. Serologic response based on AFP or DCP was significantly correlated with radiologic response, and this was confirmed by landmark analysis (P < .001). DCP and AFP responders had better times to progression and overall survival than nonresponders (P < .001). Cox models revealed that both serologic responses were independent estimates of survival (hazard ratios, 0.11 for DCP and 0.14 for AFP; P < .001).

CONCLUSIONS:

After transarterial chemoembolization for HCC, DCP response may be a useful surrogate endpoint of immediate and prolonged clinical outcomes, along with AFP response.

• Authors: Won-Hyeong Park, Ju-Hyun Shim, Seung-Bong Han, Hyung-Jin Won, Yong-Moon Shin, Kang-Mo Kim, Young-Suk Lim, Han-Chu Lee
• Journal: Journal of vascular and interventional radiology : JVIR (J Vasc Interv Radiol) Vol. 23 Issue 7 Pg. 927-36 (Jul 2012) ISSN: 1535-7732 [Electronic] United States
• PMID: 22633621 (Publication Type: Clinical Trial, Journal Article)
• Copyright: Copyright © 2012 SIR. Published by Elsevier Inc. All rights reserved.

Chemical References

• Antineoplastic Agents
• Biomarkers
• Hemostatics
• Protein Precursors
• acarboxyprothrombin
• Prothrombin

Topics

• Aged
• Antineoplastic Agents (therapeutic use)
• Biomarkers (blood)
• Carcinoma, Hepatocellular (diagnosis, epidemiology, therapy)
• Chemoembolization, Therapeutic (statistics & numerical data)
• Endpoint Determination (methods, statistics & numerical data)
• Female
• Hemostatics (therapeutic use)
• Humans
• Liver Neoplasms (diagnosis, epidemiology, therapy)
• Male
• Middle Aged
• Outcome Assessment, Health Care (methods, statistics & numerical data)
• Prevalence
• Protein Precursors (blood)
• Prothrombin
• Reproducibility of Results
• Republic of Korea (epidemiology)
• Sensitivity and Specificity
• Treatment Outcome