AFP role in predicting recurrence of hepatocellular carcinoma after living donor liver transplantation in HCV patients

Abstract

HCC is one of the leading causes of death worldwide. Liver transplantation including living donor transplantation is the best available treatment. We have analyzed our experience with LDLT (living donor liver transplantation) in patients with HCC and HCV in order to determine if alpha feto-protein (AFP) is a better predictor of recurrence than the tumor burden. We have identified all patients with HCV related liver disease and HCC who have undergone LDLT in one center during the period from December 2000 to December 2014. Outcomes from the prospective database were compared for patients who met Milan criteria (single tumor ≤5 cm, maximum of 3 total tumors with none >3 cm) or not. Uni-and multi-variable analyses of factors influencing recurrence free survival (RFS) were performed. A total of 142 patients with HCC and HCV associated liver disease underwent LDTL during the study period. RFS was 96.4% at 1 year, 91.8% at 3 years and 91.8% at 5 years. Gender, Model for End-stage Liver Disease (MELD), pre-transplant therapy, AFP level, tumor number, total tumor size were predictors of recurrence in univariable analysis. In multivariable analysis MELD score (Hazard ratio (HR) 1.16) and Log10 AFP (HR 3.14) were predictors of RFS. In the ROC curve analysis with an AUC of 0.76 the optimal cutoff value of AFP was 26 ng/mL. In conclusion, MELD score and pre-transplant AFP predict recurrence after LDLT for HCC with HCV infection.

The role of preoperative albumin‐bilirubin grade for oncological risk stratification in liver transplant patients with hepatocellular carcinoma

“…Two large registry studies identified (lab) MELD score as an independent predictor of post‐LT mortality, with tumor relapse being the predominant cause . In addition, it was shown to correlate with tumor angioinvasiveness and HCC recurrence …”

“…In contrast to unpredictable determinants like donor status, allograft quality, and surgical trauma, the patients’ functional status and performance may be accurately assessed . In this context, pre‐LT background liver cirrhosis and related hepatic dysfunction are increasingly assumed to worsen post‐LT tumor‐specific outcome, most probably by induction of cancerogenic proinflammatory and immune‐depressive mechanisms . The albumin‐bilirubin (ALBI) score has recently been established as a novel evidence‐based and easily available tool for the assessment of hepatic functional reserve .…”

Expression of the Wnt ligands gene family and its relationship to prognosis in hepatocellular carcinoma

“…In recent years, a number of novel biomarkers, such as AFP [41, 42], glypican 3 [43], Osteopontin [44], CXCL1 [45], UQCRH [46], TIP30 [47], neutrophil–lymphocyte ratio [48], have emerged for diagnosing HCC and predicting patient outcome. Among these biomarkers, AFP is a well-known serum diagnostic and prognostic biomarker for HCC [49].…”

Liver transplantation for hepatocellular carcinoma - non-cancer factors and implications for improving outcome beyond standard tumor criteria

“…)MELD score as an independent predictor of microvascular invasion (MVI) on explant pathology, which in turn was the most important factor of poor cancer-specific outcome. Others have recently confirmed the oncological significance of background cirrhosis severity in the liver transplant setting [52][53][54] . In a series of 243 transplant candidates with HCC, Faitot et al [55] demonstrated that clinically evident portal PH was an independent promoter of drop out from the waiting list due to tumor progression.…”

“…Komorowski et al . [53] 142 (lab.) MELD score Apart from AFP level, pretransplant calculated MELD score turned out to be an independent and significant predictor of RFS (HR = 1.16)…”