Highlights for α-fetoprotein in determining prognosis and treatment monitoring for hepatocellular carcinoma

Table 1 Main characteristics and results of eligible studies

Author	Year	Country	OS		PFS		Overall response rate	Disease control rate
			Univariate analysis	Multivariate analysis	Univariate analysis	Multivariate analysis
Chen et al[21]	2005	China	S	S	N/A	N/A	N/A	N/A
Chan et al[20]	2009	China	S	S	N/A	N/A	P	P
Riaz et al[27]	2009	United States	S	S	N/A	N/A	P	P
Vora et al[29]	2009	United States	N/A	NS	N/A	NS	P	P
Shao et al[28]	2010	China	N/A	S	N/A	S	P	P
Kim et al[23]	2011	South Korea	S	S	S	S	P	P
Yau et al[30]	2011	China	S	S	S	S	N/A	N/A
Kao et al[22]	2012	China	N/A	S	N/A	N/A	N/A	N/A
Lee et al[24]	2012/H	South Korea	S	S	S	NS	P	P
Lee et al[24]	2012/C	South Korea	S	S	S	NS	P	P
Memon et al[25]	2012	United States	S	S	N/A	N/A	C	N/A
Personeni et al[26]	2012	Italy	N/A	S	N/A	N/A	N/A	N/A

2012/H: Hepatic arterial infusional chemotherapy study; 2012/C: Concurrent chemoradiation therapy study; S: Significant relationship between α-fetoprotein (AFP) response and survival; NS: No significant relationship between AFP response and survival; N/A: Not available or not applicable; P: Directly provided by the article; C: Need to be calculated by the data provided by the article; OS: Overall survival; PFS: Progression-free survival.

Table 2 Characteristics and demographic information of eligible studies

Author	Year	Treatment	HCC stage	AFP change level (%)	No. of patients
					Study size (n = 974)	M/F (776/198)	AFP response (n = 463)
Chen et al[21]	2005	Sys/thalidomide	I-III	50	42	33/9	10 (23.8%)
Chan et al[20]	2009	Sys/doxorubicin or PIAF	I-III	20	117	104/13	47 (40.2%)
Riaz et al[27]	2009	Loc/chemoembolization or radioembolization	I-IV	50	125	91/34	81 (64.8%)
Vora et al[29]	2009	Sys/five systemic regimens	I-III	50	107	78/29	18 (16.8%)
Shao et al[28]	2010	Sys/Antiantiogenic agents	I-II	20	72	65/7	12 (16.7%)
Kim et al[23]	2011	Loc/chemoradiotherapy	III-IV	50	149	127/22	101 (67.8%)
Yau et al[30]	2011	Sys/sorafenib	II-IV	20	41	36/5	9 (21.9%)
Kao et al[22]	2012	Loc/radiofrequency ablation	I-III	20	58	34/24	46 (79.3%)
Lee et al[24]	2012/H	Loc/HAIC	III-IV	20	60	49/11	25 (41.7%)
Lee et al[24]	2012/C	Loc/CCRT	III-IV	20	67	55/12	52 (77.6%)
Memon et al[25]	2012	Loc/transarterialtherapy	I-III	50	51	30/21	30 (58.8%)
Personeni et al[26]	2012	Sys/sorafenib	I-III	20	85	74/11	32 (37.6%)

Sys: System treatment; Loc: Locoregional therapy; HAIC: Hepatic artery infusion chemotherapy; CCRT: Concurrent chemoradiation therapy. 2012/H: HAIC study of Lee et al; 2012/C: CCRT study of Lee et al; M/F: Male/female. HCC: Hepatocellular carcinoma; AFP: α-fetoprotein.

Table 3 Results of survival analyses related to α-fetoprotein response

Author	Year	Overall survival			Progression-free survival
		HR	95%CI	P value	HR	95%CI	P value
Chen et al[21]	2005	0.242	0.10-0.61	0.003	-	-	-
Chan et al[20]	2009	0.412	0.27-0.63	0.0001	-	-	-
Riaz et al[27]	2009	0.3712	0.13-1.011	0.0002	-	-	-
Vora et al[29]	2009	0.952	0.73-1.231	0.88	0.482	0.15-1.451	0.09
Shao et al[28]	2010	0.362	0.15-0.83	0.017	0.312	0.14-0.67	0.003
Kim et al[23]	2011	0.432	0.29-0.65	0.001	0.482	0.33-0.70	0.001
Yau et al[30]	2011	0.32	0.09-1.02	0.05	0.312	0.13-0.76	0.01
Kao et al[22]	2012	0.1812	0.02-1.67	0.023	-	-	-
Lee et al[24]	2012/H	0.432	0.23-0.81	0.009	0.672	0.35-1.27	0.22
Lee et al[24]	2012/C	0.332	0.15-0.75	0.008	0.972	0.42-2.25	0.97
Memon et al[25]	2012	0.142	0.02-0.83	0.03	-	-	-
Personeni et al[26]	2012	0.522	0.31-0.85	0.009	-	-	-

¹Calculated result from data presented in article;

²Multivariate result; -: Not performed; 2012/H: Hepatic arterial infusional chemotherapy study; 2012/C: Concurrent chemoradiation therapy study; HR: Hazard ratio; AFP: α-fetoprotein.

Table 4 Results of overall response rate and disease control rate analysis

Author	Year	Overall response rate (%)			Disease control rate (%)
		AFP responders	AFP nonresponders	RR1	AFP responders	AFP nonresponders	RR1
Chen et al[21]	2005	-	-	-	-	-	-
Chan et al[20]	2009	46.8	7.1	0.57	91.5	41.4	0.15
Riaz et al[27]	2009	43.5	31.6	0.61	91.3	68.4	0.22
Vora et al[29]	2009	25.0	10.0	0.83	93.8	56.7	0.14
Shao et al[28]	2010	33.0	8.0	0.73	83.0	35.0	0.26
Kim et al[23]	2011	44.5	12.5	0.63	87.1	58.3	0.50
Yau et al[30]	2011	-	-	-	-	-	-
Kao et al[22]	2012	-	-	-	-	-	-
Lee et al[24]	2012/H	36.0	8.6	0.70	64.0	45.7	0.66
Lee et al[24]	2012/C	36.5	20.0	0.79	80.8	66.7	0.58
Memon et al[25]	2012	36.7	7.7	0.69	-	-	-
Personeni et al[26]	2012	-	-	-	-	-	-

¹Calculated result from data presented in article; 2012/H: Hepatic arterial infusional chemotherapy study; 2012/C: Concurrent chemoradiation therapy study; -: Not performed; AFP: α-fetoprotein; RR: Relative risk.