Predictability of clinical outcomes after external beam radiotherapy for hepatocellular carcinoma according to tumor marker dynamics

Signal changes after high dose irradiation on MRI make it difficult to assess the therapeutic response of hepatocellular carcinoma (HCC). To overcome the limitation of imaging work-up, our study predicted clinical outcomes through tumor marker dynamics in HCC after external beam radiotherapy (EBRT)....

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Bibliographic Details
Published in:PloS one Vol. 20; no. 5; p. e0323450
Main Authors: Park, Sunmin, Rim, Chai Hong, Jung, Young Kul, Yim, Hyung Joon, Chung, Hwan Hoon, Yoon, Won Sup
Format: Journal Article
Language:English
Published: United States Public Library of Science 20.05.2025
Public Library of Science (PLoS)
Subjects:
Adult
Aged
alpha-Fetoproteins - metabolism
Biology and Life Sciences
Biomarkers
Biomarkers, Tumor - blood
Biomarkers, Tumor - metabolism
Blood clots
Carcinoma, Hepatocellular - blood
Carcinoma, Hepatocellular - metabolism
Carcinoma, Hepatocellular - mortality
Carcinoma, Hepatocellular - pathology
Carcinoma, Hepatocellular - radiotherapy
Care and treatment
Chemotherapy
Clinical outcomes
Female
Hepatitis B
Hepatocellular carcinoma
Hepatoma
Humans
Irradiation
Liver cancer
Liver Neoplasms - blood
Liver Neoplasms - metabolism
Liver Neoplasms - mortality
Liver Neoplasms - pathology
Liver Neoplasms - radiotherapy
Magnetic resonance imaging
Male
Measurement
Medical prognosis
Medicine and Health Sciences
Metastasis
Middle Aged
Multivariate analysis
Patient outcomes
Patients
Physical Sciences
Portal vein
Prognosis
Protein Precursors
Prothrombin - metabolism
Radiation dosage
Radiation therapy
Radiotherapy
Remission
Research and Analysis Methods
Retrospective Studies
Sensitivity
Simulation
Thrombosis
Treatment Outcome
Tumor markers
Tumors
Slovenia
United States > US
ISSN:1932-6203, 1932-6203
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Description
Summary:Signal changes after high dose irradiation on MRI make it difficult to assess the therapeutic response of hepatocellular carcinoma (HCC). To overcome the limitation of imaging work-up, our study predicted clinical outcomes through tumor marker dynamics in HCC after external beam radiotherapy (EBRT). As a single-center retrospective study, those who underwent conventional fractionated EBRT for viable HCC from 2010 to 2021 were analyzed. Patients with elevated tumor markers of AFP ≥ 10 ng/ml or PIVKA-II ≥ 30 mAU/ml before EBRT were enrolled. Remission of AFP, PIVKA-II, and MoRAL score (=11*√PIVKA-II + 2*√AFP) from pre-EBRT to post-EBRT at 1 month and 3 months was examined. For 1-year and 2-years OS, variables of tumor markers were examined using the receiver operation characteristics (ROC). Multivariate analyses of Cox-regression for OS were conducted. Among 111 patients, 34 patients were estimated to survive more than 2-years. In multivariate analyses for OS, tumor number ( P = 0.004), portal vein tumor thrombus ( P = 0.004), and Barcelona liver cancer staging ( P < 0.001) were found to be significant. For 2-years OS, the degree of AFP remission at 3 months (rAFP_3M) had an AUC of 0.852 (95% CI: 0.758–0.946, P < 0.001), a sensitivity of 85.5%, and a specificity of 82.6% with a cut-off value of 3.7%. MoRAL score at 3 months (MoRAL_3M) had an AUC of 0.814 (95% CI: 0.728–0.900, P = 0.000), a sensitivity of 76.5%, and a specificity of 77.8% with a cut-off value of 111.64. In new multivariate analyses including the above significant factors plus either rAFP_3M or MoRAL_3M, rAFP_3M ( P < 0.001) and MoRAL_3M ( P < 0.001) were found to be independent prognostic factors in each model. This study confirmed the importance of the changed tumor marker after EBRT rather than the baseline value. Dynamic change of AFP and MoRAL score at post-EBRT 3 months could be recommended as potential indicators for clinical outcomes.
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Competing Interests: The authors have declared that no competing interests exist.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0323450