Liver transplantation for hepatocellular cancer: UCL experience in 137 adult cirrhotic patients. Alpha-foetoprotein level and locoregional treatment as refined selection criteria

Abstract

Summary Liver transplantation (LT) is a validated treatment for selected cirrhotics with hepatocellular cancer (HCC). A retrospective single center study including 137 recipients having proven HCC was done to refine inclusion criteria for LT as well as to look at impact of locoregional treatment (LRT) on outcome. At pre‐LT imaging, 42 (30.6%) patients were Milan criteria (MC)‐OUT; 28 (20.4%) were University of California San Francisco criteria (UCSFC)‐OUT. Pre‐LT LRT was performed in 109 (79.6%) patients. Multivariate analysis identified four factors to be independently predictive of recurrence: tumour number >3, AFP level ≥400 ng/ml, microvascular invasion and rejection needing anti‐lymphocytic antibodies. When considering pre‐transplant variables only, AFP level ≥400 ng/ml (HR = 5.13; P < 0.0001) was the unique risk factor for recurrence; conversely, application of LRT was protective (HR = 0.42; P = 0.04). MC‐IN patients having LRT (n = 79) had the best 5‐year tumour‐free survival (TFS) (91.6%). MC‐IN patients without LRT (n = 16) and MC‐OUT patients with LRT (n = 30) had similar good TFS (72.7% vs.77.5%); finally MC‐OUT patients without LRT (n = 12) had the worst results (45.0%; vs. 1st group: P < 0.0001). Immediate pre‐LT AFP and aggressive pre‐transplant LRT strategy, especially in MC‐OUT patients, are both important elements to further expand inclusion criteria without compromising long‐term results of HCC liver recipients.

Contribution of alpha-fetoprotein in liver transplantation for hepatocellular carcinoma

“…The most frequent cutoff value reported in the literature is 400 ng/mL. This has been reported by authors from various countries in Asia [63] , Europe [64,65] and the United States [49,59,66] . It appears to be linked to recurrence but also to the risk of dropout while on a waiting list.…”

Hepatocellular carcinoma and living donor liver transplantation; the factors associated with recurrence and survival of patients. A single center experience

“…Hepatosellüler kanserin tedavisi için yapılan karaciğer nakli sonrası görülen kanser nüksleri, bu tedavi yönteminin en kaygı verici sonuçlarından biridir (14). Bizim çalışmamızda görülen %14.7 oranındaki nüks ve nüks gelişen hastalardaki düşük sağkalım oranlarının literatürde yayınlanan önceki çalışmalarla uyumlu olduğu görüldü (3,6,15).…”

“…Çünkü bu kriterler dışında, tümörün diğer özelliklerinin de nüks ve sağkalım üzerine olan etkisi daha önce yapılan birçok çalışmada ortaya konulmuştur (14,18). Çalışmamızda da bu sonuçlara paralel olarak kanser nüksünü arttıran faktörler arasında; tümörün çapı, multifokal ve kötü diferansasyon göstermesinin önemli olduğu görüldü.…”

Selection tool alpha-fetoprotein for patients waiting for liver transplantation: How to easily manage a fractal algorithm

“…An Italian study showed that the combination of morphological and biological parameters (e.g., total tumor diameter > 8 cm and AFP > 400 ng/mL) conferred scarce survivals: patients having the last AFP value > 400 ng/mL had an eighttimes incremented risk of tumor recurrence after transplantation [9] . A monocentric Belgian study similarly identified the last AFP determination > 400 ng/mL as the most important independent predictor for tumor recurrence after LT (HR = 4.86; P = 0.01) [10] . The United Network for Organ Sharing region 6 experience showed that peak AFP value > 400 and AFP at LT > 400 ng/mL were connected with poor outcomes post-LT in patients previously treated with loco-regional treatment (LRT) [11] .…”

“…195 China 400 Lai et al [9] 2012 158 Italy 400 Ciccarelli et al [10] 2012 137 Belgium 400 Wong et al [11] 2013 211 United States 400 Yang et al [17] 2007 63 (LDLT) South Korea 1000 Zou et al [18] 2008 303 China 1000 Duvoux et al [19] 2012 435 France 1000 Hameed et al [20] 2014 211 United States 1000…”