Tumor Marker Levels before and after Curative Treatment of Hepatocellular Carcinoma as Predictors of Patients Survivals

-fetoprotein (AFP) is used as a marker for hepatocellular carcinoma (HCC), which is influenced by hepatitis. Protein induced vitamin K absence or antagonist II (PIVKA-II) is a sensitive diagnostic marker. Changes in these markers after treatment may reflect curability and predict outcome. We conducted an analysis of prognosis in 470 HCC patients who received curative treatments, and examined relationship between changes in AFP and PIVKA-II levels after 1-month of treatment in 156 patients. Subjects were divided into three groups according to changes in both levels: 1) normal (L) group before treatment, 2) normalization (N) or 3) decreased but still above normal level or unchanged (ANU) group after treatment. High AFP and PIVKA-II levels were significantly associated with poor tumor-free and overall survival. Presence of large size and advanced stage were significantly associated with prevalence of DU group. Overall survival in the AFP-L group was significantly better than those of other groups and overall survival in PIVKA-II-L and N groups were significantly better than those of PIVKA-II-ANU groups. Combination of changes in AFPANU and PIVKA-IIANU group showed the worst tumor-free and overall survivals. Multivariate analysis identified high pre-treatment levels of AFP and PIVKA-II and combination of AFPANU and PIVKA-IIANU as significant determinants of poor tumor-free and overall survival, particularly in patients who underwent hepatectomy. We conclude that high levels of AFP or PIVKA-II after treatment for HCC did not sufficiently reflect curative efficacy of treatment and reflected a poor predictor of prognosis in HCC patients. Nanashima et al., Page 3