A classification using CRP and AFP in predicting survival of early- and intermediate-stage HCC treated with TACE

BACKGROUND: The aim of the present study was to investigate the association of C-reactive protein (CRP) and alpha-fetoprotein (AFP) (CRP-AFP) classification with prognosis in early- and intermediate-stage hepatocellular carcinoma (HCC) patients after undergoing transcatheter arterial chemoembolization (TACE). METHODS: This retrospective observational study included 313 early- and intermediate-stage HCC patients who had undergone TACE. We calculated CRP-AFP score by assigning two points for CRP ≥ 1.0 mg/ml and AFP ≥ 100 ng/ml, and 1 point for CRP levels of 0.2-1.0 mg/ml. The patients were categorized into three classes according to CRP-AFP score; class A (0 points), class B (1 point), and class C (2-4 points). RESULTS: The median CRP levels were 0.14 mg/dl and the median AFP levels were 31 ng/ml. The numbers of patients in CRP-AFP classes A, B, and C were 112, 69, and 132, respectively. The median survival times of classes A, B, and C were 42.2 months, 21.5 months, and 13.2 months, respectively. CRP-AFP class was associated with prognosis independent of mALBI grade and tumor burden calculated by up-to-7 criteria (hazard ratio, 1.57; 95% confidence interval, 1.30-1.89; P < .001). The time-dependent area under the receiver operating characteristic curve of CRP-AFP class was consistently higher than those of the STATE score and modified hepatoma arterial embolization prognostic score. CONCLUSIONS: Our findings suggest that CRP-AFP classification serves as a simple and effective prognostic tool for post-TACE early- and intermediate-stage HCC patients.