Background: Initial alpha-fetoprotein (AFP) response might affect clinical outcomes after systemic chemotherapy for advanced HCC. In this study, we aimed to find the correlation between initial AFP response and intrahepatic recurrence of hepatitis B-r...
Background: Initial alpha-fetoprotein (AFP) response might affect clinical outcomes after systemic chemotherapy for advanced HCC. In this study, we aimed to find the correlation between initial AFP response and intrahepatic recurrence of hepatitis B-related HCC after RFA. Methods: A total of 615 consecutive patients underwent RFA for HBV-related HCC at Seoul National University Hospital from January 2005 to June 2010. We retrospectively collected and reviewed clinical data from electronic medical records. Patients with no available AFP data at baseline or initial serum AFP <20 ng/mL were excluded from analysis. AFP response was defined as >50% decline from baseline 1 month after RFA. Results: A total of 255 patients undergoing RFA for HBVrelated HCC were included in this study. Mean age of study population was 56.8±8.7 years and 177 (70%) were males. Two hundred and forty-six had Child-Pugh class A and 9 had class B. One hundred and thirty-two had no previous history of HCC treatment, 29 received resection, 3 for RFA, 27 for percutaneous ethanol injection, and 64 for transarterial chemoembolization. The type of recurrence was as follows; local recurrence (33): remote recurrence (112): both local and remote recurrence (13). In multivariate analysis, AFP >50% decline (HR 0.507; 95% CI 0.348-0.738; p<0.001), previous history of TACE (HR 2.149; 95% CI 1.439-3.210; p<0.001), and male gender (HR 1.715; 95% CI 1.090-2.699; p=0.020) were independent predictors of remote recurrence. Conclusions: Biologic response such as initial serum AFP decline significantly predicted intrahepatic remote recurrence after RFA for locoregional HCC. Moreover, HCC patients with initial AFP decline ≤50% after RFA should be considered for further treatment modalities.