Background: Lens culinaris agglutinin-reactive alpha-fetoprotein (AFP-L3) is a fucosylated fraction of AFP that is highly specific for hepatocellular carcinoma (HCC). We studied the relationship between AFP-L3 response and treatment outcome in terms of radiologic response and overall survival in patients undergoing transcatheter arterial chemoembolization (TACE).
Methods: We retrospectively analyzed 152 patients with advanced HCC undergoing TACE. Serum AFP-L3 and AFP levels were measured simultaneously with a novel lectin dual-label time-resolved immunofluorometric assay (lectin dual-label TRFIA). AFP-L3 response was defined as a >= 20% reduction in APP-L3 level after a minimum of 2 cycles of chemotherapy.
Results: A total of 47 AFP-L3 responders had improved median overall survival of 42.9 months compared with 15.4 months in nonresponders (P < 0.0001), and APP-L3 response was strongly associated with radiologic response (P < 0.0001). The combination of AFP-L3 response and serum AFP response provided further prognostic information. On multivariate analysis, the prognostic value of APP-L3 response was independent of maximum tumor diameter and BCLC stage.
Conclusion:A significant reduction in AFP-L3 in patients with advanced HCC is an important predictor of survival. Achieving an APP-L3 response should be one of the therapeutic intents of TACE. (C) 2014 Elsevier B.V. All rights reserved.
[1]Shanghai Jiao Tong Univ, Sch Med, Renji Hosp, Dept Nucl Med, Shanghai 200127, Peoples R China.
[2]Shanghai Jiao Tong Univ, Sch Med, Inst Hlth Sci, Shanghai 200025, Peoples R China.
[3]Chinese Acad Sci, Shanghai Inst Biol Sci, Shanghai 200025, Peoples R China.
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