Outcomes of Transarterial Chemoembolization in Patients of Alpha-Fetoprotein Secreting Hepatocellular Carcinoma

Abstract

Background and Aim: Hepatocelluar carcimona (HCC) is the fifth most common malignant tumor worldwide and the third most frequent cause of cancer-related death globally. Large proportion of patients has advanced disease at outset for which transarterial chemoembolization (TACE) is the recommended therapy. Alpha-fetoprotein (AFP) is the biomarker for HCC and about 70% of HCC patients has AFP secreting tumors. This study was designed to evaluate the outcome of TACE in AFP secreting HCC patients in comparison with patients of the non-AFP secreting HCC. Methods: In this retrospective study, case records of HCC patients treated with TACE between August 2005 and September 2014 were examined. Records having complete clinical, demographical, biochemical, imaging profile and follow up details were included. AFP cut off of 20 ng/ml was used to divide the patients into two groups and comparisons made. The tumor response and survival rate was estimated. Results: HCC patients (N = 125) were studied of which 6 patients had incomplete data were excluded. Of the remaining 119 patients—Group 1-AFP <20 ng/ml were 42 and group 2-AFP < 20 ng/ml were 77 patients. These patients had a huge difference in the AFP levels but other parameters of age and sex distribution, liver function tests, stage and etiology of HCC were quite similar. Group 2 patients had significantly larger mean size of the index mass (6.3 vs 4.2 cm, P 0.01) and required more number of TACE sessions. The tumor response was comparable, however the proportion of patients developing progressive disease was more in group 2(58.4% vs 42.9%). The Kaplan–Meir survival estimate at 50 months showed significantly less survival of group 2 patients [19.5 (0.10–0.30) months vs. 42.5 (0.25–0.58) months, P = 0.0008]. Conclusions: Following TACE, AFP secreting HCC patients achieve similar tumor response rates but have poorer survival compared to non-AFP secreting HCC patients.