Clinical usefulness of double biomarkers AFP and PIVKA-II for subdividing prognostic groups in locally advanced hepatocellular carcinoma

Background & AimsIn this study, we investigated the clinical usefulness of AFP and PIVKA-II in subdividing prognostic groups in patients with locally advanced HCC treated locally. MethodsPatients who had undergone local treatment for locally advanced HCC between 2001 and 2006 were enrolled. Response to treatment was defined as a reduction in AFP or PIVKA-II by more than 50% from baseline levels at 1month after the treatment completion. Patients were divided according to their AFP and PIVKA-II response: AP [AFP response (+) and PIVKA-II response (+)]; AP [AFP response (+) and PIVKA-II response (-)]; AP [AFP response (-) and PIVKA-II response (+)]; AP [AFP response (-) and PIVKA-II response (-)]. Clinical characteristics and prognosis were compared between groups. ResultsPatients were subdivided into four groups by the change in the level of the biomarkers AFP and PIVKA-II, and the survival outcomes of each group were distinct. Among patients with an AFP response, further subdivision by PIVKA-II response revealed that those in the AP group had a longer median progression-free survival (PFS) and overall survival (OS) compared with those in the AP group (PFS: 16.2 vs. 5.1months, P=0.009; OS: 26.3 vs. 7.3months, P=0.017). Combination of AFP and PIVKA-II response showed a predictive power for PFS and OS comparable to radiological criteria and better than AFP response alone. ConclusionsIn patients with locally advanced HCC, the use of a combination of two biomarkers, AFP and PIVKA-II, appears useful in predicting treatment outcomes through the subdivision of prognostic groups.