Prediction of Prognosis of Intermediate-Stage HCC Patients: Validation of the Tumor Marker Score in a Nationwide Database in Japan

The Liver Cancer Study Group Of Japan

Research output: Contribution to journalArticle

Abstract

Background/Aim: Adequate assessment of transcatheter arterial chemoembolization (TACE)-refractory status has become more important for switching treatment in intermediate-stage (BCLC-B) hepatocellular carcinoma (HCC) patients treated with TACE. The usefulness of a previously proposed tumor marker score for predicting prognosis of BCLC-B HCC patients treated with TACE was investigated. Methods: Using a nationwide database, we examined the records of 1,306 naïve BCLC-B HCC with Child-Pugh A who were treated from 2001 to 2007, after excluding those with missing data (hepatic function or tumor markers) or cases with a single large tumor. Alpha-fetoprotein (AFP) ≥100 ng/mL, fucosylated AFP (AFP-L3) ≥10%, and des-gamma-carboxy prothrombin ≥100 mAU/mL were markers used to define positive cases. The number of positive tumor markers was used as a prognostic score, and its predictive value was evaluated in a retrospective manner. Results: Median survival time became shorter along with increased score (0, 1, ≥2 = 4.8, 3.8, 3.2 years, respectively; p < 0.01). Tumor marker score (≥2; hazard ratio [HR] 1.675, 95% confidence interval [CI] 1.372-2.044, p < 0.001), serum levels of albumin (≥3.5 g/dL; HR 0.726, 95% CI 0.528-0.997, p = 0.048), and up-to-7 criteria (HR 1.673, 95% CI 1.400-2.000, p < 0.001) were significant prognostic factors for death in the Cox hazard multivariate analysis. Conclusion: Tumor marker score had a useful predictive prognostic value in BCLC-B HCC treated with TACE. Especially in patients with a tumor marker score of 2 or greater, a poor therapeutic response should be expected, and appropriate judgement of TACE-refractory status is necessary.

Original languageEnglish
JournalLiver Cancer
DOIs
Publication statusPublished - 2019 Jan 1

Fingerprint

Tumor Biomarkers
Hepatocellular Carcinoma
Japan
Databases
alpha-Fetoproteins
Confidence Intervals
Serum Albumin
Multivariate Analysis
Survival
Liver
Therapeutics
Neoplasms

Keywords

  • Alpha-fetoprotein
  • BCLC-B
  • Des-gamma-carboxy prothrombin
  • Fucosylated alpha-fetoprotein
  • Hepatocellular carcinoma
  • Prognosis
  • TACE-refractory status

ASJC Scopus subject areas

  • Hepatology
  • Oncology

Cite this

Prediction of Prognosis of Intermediate-Stage HCC Patients : Validation of the Tumor Marker Score in a Nationwide Database in Japan. / The Liver Cancer Study Group Of Japan.

In: Liver Cancer, 01.01.2019.

Research output: Contribution to journalArticle

@article{9b9772b0bcc146c5b9b2e312a15e3cbd,
title = "Prediction of Prognosis of Intermediate-Stage HCC Patients: Validation of the Tumor Marker Score in a Nationwide Database in Japan",
abstract = "Background/Aim: Adequate assessment of transcatheter arterial chemoembolization (TACE)-refractory status has become more important for switching treatment in intermediate-stage (BCLC-B) hepatocellular carcinoma (HCC) patients treated with TACE. The usefulness of a previously proposed tumor marker score for predicting prognosis of BCLC-B HCC patients treated with TACE was investigated. Methods: Using a nationwide database, we examined the records of 1,306 na{\"i}ve BCLC-B HCC with Child-Pugh A who were treated from 2001 to 2007, after excluding those with missing data (hepatic function or tumor markers) or cases with a single large tumor. Alpha-fetoprotein (AFP) ≥100 ng/mL, fucosylated AFP (AFP-L3) ≥10{\%}, and des-gamma-carboxy prothrombin ≥100 mAU/mL were markers used to define positive cases. The number of positive tumor markers was used as a prognostic score, and its predictive value was evaluated in a retrospective manner. Results: Median survival time became shorter along with increased score (0, 1, ≥2 = 4.8, 3.8, 3.2 years, respectively; p < 0.01). Tumor marker score (≥2; hazard ratio [HR] 1.675, 95{\%} confidence interval [CI] 1.372-2.044, p < 0.001), serum levels of albumin (≥3.5 g/dL; HR 0.726, 95{\%} CI 0.528-0.997, p = 0.048), and up-to-7 criteria (HR 1.673, 95{\%} CI 1.400-2.000, p < 0.001) were significant prognostic factors for death in the Cox hazard multivariate analysis. Conclusion: Tumor marker score had a useful predictive prognostic value in BCLC-B HCC treated with TACE. Especially in patients with a tumor marker score of 2 or greater, a poor therapeutic response should be expected, and appropriate judgement of TACE-refractory status is necessary.",
keywords = "Alpha-fetoprotein, BCLC-B, Des-gamma-carboxy prothrombin, Fucosylated alpha-fetoprotein, Hepatocellular carcinoma, Prognosis, TACE-refractory status",
author = "{The Liver Cancer Study Group Of Japan} and Atsushi Hiraoka and Kojiro Michitaka and Takashi Kumada and Namiki Izumi and Masumi Kadoya and Norihiro Kokudo and Shoji Kubo and Yutaka Matsuyama and Osamu Nakashima and Michiie Sakamoto and Tadatoshi Takayama and Takashi Kokudo and Kosuke Kashiwabara and Susumu Eguchi and Tatsuya Yamashita and Masatoshi Kudo",
year = "2019",
month = "1",
day = "1",
doi = "10.1159/000495944",
language = "English",
journal = "Liver Cancer",
issn = "2235-1795",
publisher = "S. Karger AG",

}

TY - JOUR

T1 - Prediction of Prognosis of Intermediate-Stage HCC Patients

T2 - Validation of the Tumor Marker Score in a Nationwide Database in Japan

AU - The Liver Cancer Study Group Of Japan

AU - Hiraoka, Atsushi

AU - Michitaka, Kojiro

AU - Kumada, Takashi

AU - Izumi, Namiki

AU - Kadoya, Masumi

AU - Kokudo, Norihiro

AU - Kubo, Shoji

AU - Matsuyama, Yutaka

AU - Nakashima, Osamu

AU - Sakamoto, Michiie

AU - Takayama, Tadatoshi

AU - Kokudo, Takashi

AU - Kashiwabara, Kosuke

AU - Eguchi, Susumu

AU - Yamashita, Tatsuya

AU - Kudo, Masatoshi

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background/Aim: Adequate assessment of transcatheter arterial chemoembolization (TACE)-refractory status has become more important for switching treatment in intermediate-stage (BCLC-B) hepatocellular carcinoma (HCC) patients treated with TACE. The usefulness of a previously proposed tumor marker score for predicting prognosis of BCLC-B HCC patients treated with TACE was investigated. Methods: Using a nationwide database, we examined the records of 1,306 naïve BCLC-B HCC with Child-Pugh A who were treated from 2001 to 2007, after excluding those with missing data (hepatic function or tumor markers) or cases with a single large tumor. Alpha-fetoprotein (AFP) ≥100 ng/mL, fucosylated AFP (AFP-L3) ≥10%, and des-gamma-carboxy prothrombin ≥100 mAU/mL were markers used to define positive cases. The number of positive tumor markers was used as a prognostic score, and its predictive value was evaluated in a retrospective manner. Results: Median survival time became shorter along with increased score (0, 1, ≥2 = 4.8, 3.8, 3.2 years, respectively; p < 0.01). Tumor marker score (≥2; hazard ratio [HR] 1.675, 95% confidence interval [CI] 1.372-2.044, p < 0.001), serum levels of albumin (≥3.5 g/dL; HR 0.726, 95% CI 0.528-0.997, p = 0.048), and up-to-7 criteria (HR 1.673, 95% CI 1.400-2.000, p < 0.001) were significant prognostic factors for death in the Cox hazard multivariate analysis. Conclusion: Tumor marker score had a useful predictive prognostic value in BCLC-B HCC treated with TACE. Especially in patients with a tumor marker score of 2 or greater, a poor therapeutic response should be expected, and appropriate judgement of TACE-refractory status is necessary.

AB - Background/Aim: Adequate assessment of transcatheter arterial chemoembolization (TACE)-refractory status has become more important for switching treatment in intermediate-stage (BCLC-B) hepatocellular carcinoma (HCC) patients treated with TACE. The usefulness of a previously proposed tumor marker score for predicting prognosis of BCLC-B HCC patients treated with TACE was investigated. Methods: Using a nationwide database, we examined the records of 1,306 naïve BCLC-B HCC with Child-Pugh A who were treated from 2001 to 2007, after excluding those with missing data (hepatic function or tumor markers) or cases with a single large tumor. Alpha-fetoprotein (AFP) ≥100 ng/mL, fucosylated AFP (AFP-L3) ≥10%, and des-gamma-carboxy prothrombin ≥100 mAU/mL were markers used to define positive cases. The number of positive tumor markers was used as a prognostic score, and its predictive value was evaluated in a retrospective manner. Results: Median survival time became shorter along with increased score (0, 1, ≥2 = 4.8, 3.8, 3.2 years, respectively; p < 0.01). Tumor marker score (≥2; hazard ratio [HR] 1.675, 95% confidence interval [CI] 1.372-2.044, p < 0.001), serum levels of albumin (≥3.5 g/dL; HR 0.726, 95% CI 0.528-0.997, p = 0.048), and up-to-7 criteria (HR 1.673, 95% CI 1.400-2.000, p < 0.001) were significant prognostic factors for death in the Cox hazard multivariate analysis. Conclusion: Tumor marker score had a useful predictive prognostic value in BCLC-B HCC treated with TACE. Especially in patients with a tumor marker score of 2 or greater, a poor therapeutic response should be expected, and appropriate judgement of TACE-refractory status is necessary.

KW - Alpha-fetoprotein

KW - BCLC-B

KW - Des-gamma-carboxy prothrombin

KW - Fucosylated alpha-fetoprotein

KW - Hepatocellular carcinoma

KW - Prognosis

KW - TACE-refractory status

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U2 - 10.1159/000495944

DO - 10.1159/000495944

M3 - Article

AN - SCOPUS:85062061079

JO - Liver Cancer

JF - Liver Cancer

SN - 2235-1795

ER -