Prognostic value of serum alpha fetoprotein response during pre-operative chemotheraphy in hepatoblastoma: A meta-analysis

Abstract

Objective: The prognostic value of Alpha Fetoprotein (AFP) response during Preoperative Chemotherapy (POC) in Hepatoblastoma (HB) has not been defined. Only a few studies describe the ability of decline in AFP during POC and AFP levels after POC to predict outcome. The purpose of this meta-analysis is to determine if these values can predict outcome in HB. Materials and Methods: We performed a systematic review of studies reporting decline in AFP during POC and AFP levels after POC in relation to Event Free Survival (EFS). Methodological quality of eligible studies was assessed using Quality In Prognosis Studies (QUIPS). The weighted average Hazard Ratio (HR) was used to predict outcome, which was estimated using inverse variance using random effects model. Results: Eight studies (n= 216) investigated AFP decline during POC and four studies (n=125) investigated AFP values after POC both in relation to EFS. Cut-off values for AFP decline during POC and AFP value after POC differed in each study. Patients with AFP decline during POC above cutoff have significant better EFS (pooled HR 0.27, 95% CI, 0.16-0.46, p<0.0001). Whereas patients with AFP values after POC below cutoff have significant better EFS (pooled HR 0.42, 95% CI, 0.21- 0.87, p= 0.02). I2 test results were 31% and 19%, respectively, indicating that there is low level of heterogeneity. Conclusions: Our meta-analysis showed that both AFP decline and its value after POC is predictive of better prognosis in HB.