Dynamic changes in serum alpha-fetoprotein predict prognosis in hepatocellular carcinoma treated with immune checkpoint inhibitors: a systematic review and meta-analysis.

Background: The impact of dynamic changes in alpha-fetoprotein (AFP) levels on the prognosis of hepatocellular carcinoma (HCC) remains controversial. Objectives: This review aims to clarify the prognostic value of dynamic changes in AFP levels in patients with HCC treated with immune checkpoint inhibitors (ICIs). Data sources and methods: PubMed, EMBASE, Cochrane Library, and Web of Science were searched to collect eligible studies published up to July 29, 2024. The Newcastle-Ottawa Scale score was used to assess the quality of included studies, and Stata 15.1 statistical software was used for statistical analysis. Results: This review included 23 studies involving 2860 patients with HCC. Following treatment with ICIs, a dynamic decrease in AFP levels was significantly associated with improved overall survival (OS; hazard ratio (HR) 0.40, 95% confidence interval (CI), 0.34-0.48) and progression-free survival (PFS; HR 0.39, 95% CI, 0.34-0.45). Conversely, dynamically increased AFP levels were linked to poorer OS (HR 2.34, 95% CI, 1.69-3.23) and PFS (HR 2.62, 95% CI, 1.92-3.56). Subgroup analyses revealed that while the association with OS was influenced by factors such as treatment regimen and sample size, the prognostic value of AFP changes for PFS appeared more consistent across various subgroups. Conclusion: This review demonstrates that dynamic changes in AFP levels are significantly associated with OS and PFS in HCC patients treated with ICIs, particularly in those receiving combination ICI regimens. Trial registration: PROSPERO registration number CRD42024599795.