Alpha-fetoprotein Level Predicts Recurrence After Transplantation in Hepatocellular Carcinoma

Abstract

Hepatocellular carcinoma (HCC) is one of the leading causes of liver transplantation. In an attempt to predict their recurrence after liver transplantation, evaluation of tumor number and size, degree of histologic differentiation, and the presence of vascular invasion already have their importance established. In this context, the role of biologic markers such as alpha-fetoprotein (AFP) is still not clear. This retrospective cross-sectional study analyzed the AFP relationship with recurrence of HCC after orthotopic liver transplantation.The current study retrospectively analyzed data from 206 patients with a histopathologic confirmed HCC between 1997 and 2010.The overall survival rates at 1, 3, 5, and 14 years were 78.6%, 65.4%, 60.5%, and 38.7%, respectively. The frequency of recurrence was 15.5%, and recurrence was significantly associated with a lower survival rate (P < 0.001). No association was observed between survival and AFP level (P = 0.153). A correlation, however, was found between tumor recurrence and AFP level (P = 0.002). Univariate analysis of risk factors for recurrence revealed that an AFP level greater than 200 ng/mL, the number of tumors, the degree of cellular differentiation, and the presence of vascular invasion or satellite nodules were associated with relapse. By multivariate analysis, only an AFP level greater than 200 ng/mL remained as a risk factor.Although an elevated AFP level did not correlate with survival in HCC patients undergoing orthotopic liver transplantation, a high AFP level was associated with a 3.32-folds increase in the probability of HCC recurrence.

Limitations of predicting microvascular invasion in patients with hepatocellular cancer prior to liver transplantation

“…Therefore, as combination of morphological tumor parameters and serum HCC markers in the selection process is gaining increasing popularity among transplant centers78101316171819, the relevance of obtaining data on the presence of microvascular invasion appears to become far less important for the clinical practice. This observation corresponds to previous findings of other authors regarding no significant impact of microvascular invasion in multivariable analyses including these important features434445.…”

Serum microRNA panel for early diagnosis of the onset of hepatocellular carcinoma

“…[20] However, approximately 20% of HCC patients with low AFP level are poorly diagnosed. [21] For these patients, the 3-miRNA panel possessed significant superiority compared to AFP alone.…”

The prognostic utility of baseline alpha‐fetoprotein for hepatocellular carcinoma patients

“…Many early‐stage HCC patients do not express elevated AFP levels, and patients with chronic diseases like hepatitis and cirrhosis may have elevated serum AFP in the absence of malignancy . However, following definitive diagnosis of HCC, elevated pretreatment AFP has been described as an independent predictor of survival and recurrence in several institutional studies and reviews …”