Transarterial chemoembolization (TACE) is used as a bridging treatment in liver transplant candidates with hepatocellular carcinoma (HCC). Alpha-fetoprotein (AFP) is the main tumor marker used for HCC surveillance. The aim of this study was to assess the potential of using the AFP change after the first TACE in the prediction of complete tumor necrosis. The study comprised 101 patients with HCC who underwent liver transplantation (LT) after TACE in the period between January 2011 and December 2020. The ΔAFP was defined as the difference between the AFP value before the first TACE and AFP either before the second TACE or the LT. The receiver operator characteristics (ROC) curves were used to identify an optimal cut-off value. Complete tumor necrosis was found in 26.1% (18 of 69) and 6.3% (2 of 32) of patients with an initial AFP level under and over 100 ng/mL, respectively (p= 0.020). The optimal cut-off value of ΔAFP for the prediction of complete necrosis was a decline of ≥10.2 ng/mL and ≥340.5 ng/mL in the corresponding subgroups. Complete tumor necrosis rates were: 62.5% (5 of 8) in patients with an initial AFP < 100 ng/mL and decline of ≥10.2 ng/mL; 21.3% (13 of 61) in patients with an initial AFP < 100 ng/mL and decline of <10.2 ng/mL; 16.7% (2 of 12) in patients with an initial AFP > 100 ng/mL and decline of ≥340.5 ng/mL; and null in 20 patients with an initial AFP > 100 ng/mL and decline of <340.5 ng/mL, respectively (p= 0.003). The simple scoring system, based on the initial AFP and AFP decline after the first treatment, distinguished between a high, intermediate and low probability of complete necrosis, with an area under the ROC curve of 0.699 (95% confidence intervals 0.577 to 0.821,p= 0.001). Combining the initial AFP with its change after the first treatment enables early identification of the efficacy of TACE.
经动脉化疗栓塞（TACE）可作为肝细胞癌（HCC）患者接受肝移植前的桥接治疗。甲胎蛋白（AFP）是用于HCC监测的主要肿瘤标志物。本研究旨在评估首次TACE后AFP变化对预测肿瘤完全坏死的潜在价值。研究纳入了2011年1月至2020年12月期间接受TACE后行肝移植（LT）的101例HCC患者。ΔAFP定义为首次TACE前的AFP值与第二次TACE前或肝移植前的AFP值之差。采用受试者工作特征（ROC）曲线确定最佳截断值。在初始AFP水平低于100 ng/mL和高于100 ng/mL的患者中，肿瘤完全坏死率分别为26.1%（69例中的18例）和6.3%（32例中的2例）（p=0.020）。预测肿瘤完全坏死的最佳ΔAFP截断值在相应亚组中分别为下降≥10.2 ng/mL和≥340.5 ng/mL。完全肿瘤坏死率具体为：初始AFP<100 ng/mL且下降≥10.2 ng/mL的患者为62.5%（8例中的5例）；初始AFP<100 ng/mL且下降<10.2 ng/mL的患者为21.3%（61例中的13例）；初始AFP>100 ng/mL且下降≥340.5 ng/mL的患者为16.7%（12例中的2例）；而初始AFP>100 ng/mL且下降<340.5 ng/mL的20例患者中无一发生完全坏死（p=0.003）。基于初始AFP水平及首次治疗后AFP下降的简易评分系统，可区分高、中、低完全坏死概率，其ROC曲线下面积为0.699（95%置信区间0.577-0.821，p=0.001）。联合初始AFP水平及其首次治疗后的变化，能够早期评估TACE的疗效。
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