*Purpose: Hepatocellular carcinoma (HCC) treatment with locoregional therapy (LRT) is standard treatment to downstage within Milan Criteria. In this study, we retrospectively analyzed early-stage HCC patients undergoing de novo LRT and monitored intention-to-treat (ITT) survival. We also prospectively monitored a subset of early-stage HCC patients to determine whether additional HCC biomarkers would aid in predicting ITT survival compared to AFP alone.

*Methods: All studies were IRB-approved at our institution. HCC patients undergoing de novo DEB-TACE from Aug 2015 – May 2019 were reviewed. Blood was collected from a subset of these patients (n=51) immediately prior to LRT. Plasma was used to measure HCC biomarkers (AFP, des-γ-carboxy prothrombin (DCP), and Lens culinaris agglutinin-reactive α-fetoprotein (AFP-L3)) in samples with the μTASWako i30 autoanalyzer. ITT endpoint included patients that received liver transplantation or dropout due to tumor progression.

*Results: 160 treatment-naïve HCC patients were analyzed with 71% male and 65% Hepatitis C. Milan Criteria and AFP elevation alone was not predicitive ITT survival, however patients with AFP > 100ng/ml had significantly lower ITT survival. Univariate analysis revealed patients with tumor progression had larger lesions (P<0.0001), cumulative lesion size (P<0.0001), and higher HCC biomarkers AFP (P=0.39), AFP-L3 (P=0.002), and DCP (P=0.005). ITT survival was significantly lower in patients presenting with elevated single biomarkers [AFP >100 (P<0.0001), AFP-L3 (P<0.0001), and DCP (P<0.0001)], primary lesion >3cm (P<0.0001), and cumulative lesion size >3cm (P<0.001). Analysis of patients stratified by HCC biomarkers revealed patients presenting with AFP elevation and an additional biomarker had worse ITT survival and were at greater risk of waitlist dropout.

*Conclusions: AFP alone can identity patients at risk of waitlist dropout with higher risk of recurrence post transplant. However, the addition of AFP-L3 and DCP biomarkers can identify a patient population prior to LRT intervention at risk of tumor progression from the waitlist.

« Back to 2020 American Transplant Congress