The current status of tumor markers as biomarkers in the era of immunotherapy for hepatocellular carcinoma: alpha-fetoprotein alone is not sufficient.

IF 2.5 3区医学 Q3 ONCOLOGY

Oncology Pub Date : 2025-02-03 DOI:10.1159/000543405

Atsushi Hiraoka, Masatoshi Kudo, Toshifumi Tada, Takeshi Hatanaka, Satoru Kakizaki, Kazuya Kariyama, Hideko Ohama, Kunihiko Tsuji, Toru Ishikawa, Koichi Takaguchi, Ei Itobayashi, Hidenori Toyoda, Tomomitsu Matono, Yutaka Yata, Chikara Ogawa, Atsushi Naganuma, Joji Tani, Masanori Atsukawa, Takashi Nishimura, Kazuto Tajiri, Kazuhito Kawata, Hisashi Kosaka, Hidekatsu Kuroda, Masashi Hirooka, Hiroki Nishikawa, Fujimasa Tada, Shinichiro Nakamura, Yuki Kanayama, Kazuhiro Nouso, Hironori Tanaka, Kazunari Tanaka, Michitaka Imai, Akemi Tsutsui, Takuya Nagano, Tomoko Aoki, Yuichi Koshiyama, Asahiro Morishita, Norio Itokawa, Tomomi Okubo, Taeang Arai, Shinya Fukunishi, Hidenao Noritake, Yoshiko Nakamura, Osamu Yoshida, Hirayuki Enomoto, Masaki Kaibori, Yoichi Hiasa, Takashi Kumada

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引用次数: 0

Abstract

Background/aim: Rapid development of systemic treatments has resulted in improved prognosis for unresectable hepatocellular carcinoma (uHCC) patients. Since immune therapy shows a favorable therapeutic efficacy, use of tumor markers as biomarkers for monitoring treatment response is necessary. This study aimed to elucidate changes in positive rates of 3 available tumor markers in Japan, including alpha-fetoprotein (AFP), des-gamma-carboxy prothrombin (DCP), and lens culinaris agglutinin-reactive AFP (AFP-L3) in uHCC patients treated with systemic therapies over time.

Material/methods: From 2009 to 2023, 1470 uHCC patients with data of tumor markers before starting treatment were enrolled. The positivity cut-off value for AFP was 20 ng/mL, for AFP-L3 was 10%, and for DCP was 40 mAU/mL. After dividing the 15 years examined into three periods of five years each (period I, II, III), clinical features of the enrolled patients were evaluated, retrospectively.

Results: The percentage of Barcelona Clinic Liver Cancer stage B patients who received systemic therapy increased from period I to III (27.7%, 38.5%, 46.6%, respectively, P<0.001), which was also seen for HCC patients with a non-viral etiology (alcohol and others) (29.9%, 39.7%, 49.6%, respectively P<0.001). Positive rates for AFP (67.8%, 62.1%, 50.8%, respectively) and DCP (84.1%, 80.5%, 72.7%, respectively) were decreased (each P<0.001), while the AFP-L3 rate did not show a significant change (54.4%, 57.7%, 51.9%, respectively P=0.390). Among the AFP-negative patients, the rate of positive for DCP or AFP-L3 was increased (24.4%, 28.1%, 35.4%, respectively, P=0.002).

Conclusion: Based on introduction of systemic treatment in an early stage and increasing numbers of HCC cases with a non-viral etiology, the positive rate of AFP level has been declining. Thus, determination of DCP and AFP-L3 in addition to AFP as markers should be more actively utilized in clinical practice, as well as clinical trials for monitoring and evaluating treatment response in this era of combination immunotherapy as a powerful treatment.

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来源期刊

Oncology 医学-肿瘤学

CiteScore

6.00

自引率

2.90%

发文量

审稿时长

6-12 weeks

期刊介绍： Although laboratory and clinical cancer research need to be closely linked, observations at the basic level often remain removed from medical applications. This journal works to accelerate the translation of experimental results into the clinic, and back again into the laboratory for further investigation. The fundamental purpose of this effort is to advance clinically-relevant knowledge of cancer, and improve the outcome of prevention, diagnosis and treatment of malignant disease. The journal publishes significant clinical studies from cancer programs around the world, along with important translational laboratory findings, mini-reviews (invited and submitted) and in-depth discussions of evolving and controversial topics in the oncology arena. A unique feature of the journal is a new section which focuses on rapid peer-review and subsequent publication of short reports of phase 1 and phase 2 clinical cancer trials, with a goal of insuring that high-quality clinical cancer research quickly enters the public domain, regardless of the trial’s ultimate conclusions regarding efficacy or toxicity.