Prediction of Prognosis of Intermediate-Stage HCC Patients: Validation of the Tumor Marker Score in a Nationwide Database in Japan

Atsushi Hiraoka, Kojiro Michitaka, Takashi Kumada, Namiki Izumi, Masumi Kadoya, Norihiro Kokudo, Shoji Kubo, Yutaka Matsuyama, Osamu Nakashima, Michiie Sakamoto, Tadatoshi Takayama, Takashi Kokudo, Kosuke Kashiwabara, Susumu Eguchi, Tatsuya Yamashita, Masatoshi Kudo

Research output: Contribution to journalArticlepeer-review

21 Citations (Scopus)


Background/Aim: Adequate assessment of transcatheter arterial chemoembolization (TACE)-refractory status has become more important for switching treatment in intermediate-stage (BCLC-B) hepatocellular carcinoma (HCC) patients treated with TACE. The usefulness of a previously proposed tumor marker score for predicting prognosis of BCLC-B HCC patients treated with TACE was investigated. Methods: Using a nationwide database, we examined the records of 1,306 naïve BCLC-B HCC with Child-Pugh A who were treated from 2001 to 2007, after excluding those with missing data (hepatic function or tumor markers) or cases with a single large tumor. Alpha-fetoprotein (AFP) ≥100 ng/mL, fucosylated AFP (AFP-L3) ≥10%, and des-gamma-carboxy prothrombin ≥100 mAU/mL were markers used to define positive cases. The number of positive tumor markers was used as a prognostic score, and its predictive value was evaluated in a retrospective manner. Results: Median survival time became shorter along with increased score (0, 1, ≥2 = 4.8, 3.8, 3.2 years, respectively; p < 0.01). Tumor marker score (≥2; hazard ratio [HR] 1.675, 95% confidence interval [CI] 1.372-2.044, p < 0.001), serum levels of albumin (≥3.5 g/dL; HR 0.726, 95% CI 0.528-0.997, p = 0.048), and up-to-7 criteria (HR 1.673, 95% CI 1.400-2.000, p < 0.001) were significant prognostic factors for death in the Cox hazard multivariate analysis. Conclusion: Tumor marker score had a useful predictive prognostic value in BCLC-B HCC treated with TACE. Especially in patients with a tumor marker score of 2 or greater, a poor therapeutic response should be expected, and appropriate judgement of TACE-refractory status is necessary.

Original languageEnglish
Pages (from-to)403-411
Number of pages9
JournalLiver Cancer
Issue number5
Publication statusPublished - 2019 Oct 1


  • Alpha-fetoprotein
  • BCLC-B
  • Des-gamma-carboxy prothrombin
  • Fucosylated alpha-fetoprotein
  • Hepatocellular carcinoma
  • Prognosis
  • TACE-refractory status

ASJC Scopus subject areas

  • Hepatology
  • Oncology


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