Prognosis of first-line tumor directed therapy for hepatocellular carcinoma using a combination of AFP, AFP-L3, and DCP

Presenter: Paul Thevenot PhD | Ochsner Health System Background: The expanded biomarker panel consisting of α-fetoprotein (AFP), AFP-L3%, and des-γ-carboxy prothrombin (DCP) has improved surveillance early detection hepatocellular carcinoma (HCC). biomarkers individually, when elevated, have also been linked to aggressive tumor biology including vascular invasion advanced staging. With increased clinical utilization on the horizon, we investigated role using combinations at time diagnosis correlating outcomes liver transplantation. Methods: This prospective study was conducted a single-center in HCC patients presenting multi-disciplinary board for liver-directed therapy (LDT) evaluation bridge transplantation (8/30/16 – 10/16/20). AFP, DCP were assayed day first line LDT μTASWako i30 instrument. Additional analyzed parameters obtained prior first-line monitored transplant outcome as primary endpoint. Results: Consented analysis 140 treatment naïve undergoing with transarterial chemoembolization, Ytrrium-90, or microwave ablation. median cohort age 61 years majority demographics male (74%) hepatitis C etiology (59%). Tumor burden 82% within Milan MELD-Na prioritization score 11. Study endpoint breakdown 29% transplanted, dropout due progression, 24% censored from endpoint, 18% remaining waitlist active analysis. Median values 10 ng/mL 7% AFP-L3, 3.1 DCP. Forty-four percent negative all three while 14% triple positive. Univariate each threshold associated progression (OR 5.6 AFP > 20 ng/mL, 4.8 AFP-L3 >10%, 8.8 >7.5 ng/mL). Analysis based status (triple negative, only, positive AFP-L3% and/or DCP) revealed an association between positivity largest lesion size (P < 0.001). showed lesion, individual biomarker, along 2 survival. Controlling separate multivariate analyses, (HR 4.8), 2.2), having 6.0) remained In analysis, more than had significant lower Biomarker response 3.2). Conclusion: (AFP, can identify high risk following LDT. may provide opportunity optimize modality profile independent radiographic burden.