Dynamic Changes in Serum AFP, Albumin and ALBI after Radioembolization in Patients with Unresectable Hepatocellular Carcinoma with High or Low Alpha-Fetoprotein Levels.

Abstract

Background: 1.1.Yttrium-90 trans arterial radioembolization (TARE) is an established locoregional therapy for unresectable hepatocellular carcinoma (HCC). Baseline biomarkers are widely used for prognosis, but the clinical significance of post-TARE changes in tumour and liver-function biomarkers remains uncertain. ALBI and related measures have emerged as objective prognostic indices of hepatic reserve and HCC.

Aim: 1.2.To identify early post-TARE biomarker changes associated with overall survival.

Methods: 1.3.We retrospectively analysed 276 nonsurgical patients with HCC who underwent TARE and had available survival data. Changes in routinely measured tumour, inflammatory, hematologic, and liver-function variables were assessed at 1, 3, 6, and 12 months, when available.

Results: 1.4.Biomarker changes were evident by 1 month, particularly in AFP, albumin, and ALBI grade, in patients with both low and high baseline AFP. Changes in PALBI, mALBI, GGT, CRP, and bilirubin were also observed. Increased or stable albumin was associated with longer survival at all assessed time points in both baseline AFP strata. Decreased AFP was associated with longer survival consistently in patients with high baseline AFP and at later time points in patients with low baseline AFP. Early bilirubin decreases were also associated with longer survival. Patients whose NPS phenotype decreased had substantially longer median survival than those with increased phenotype.

Conclusions: 1.5.Early post-TARE changes in albumin and AFP were associated with overall survival in this retrospective cohort. These findings support future prospective validation of dynamic biomarker changes.