Liver Transplantation for Hepatocellular Carcinoma: A Model Including α-Fetoprotein Improves the Performance of Milan Criteria

Duvoux, Christophe; Roudot‐Thoraval, Françoise; Decaens, Thomas; Pessione, Fabienne; Badran, Hanaa M.; Piardi, Tullio; Francoz, Claire; Compagnon, Philippe; Vanlemmens, Claire; Dumortier, Jérôme; Dharancy, Sébastien; Gugenheim, Jean; Bernard, Pierre–Henri; Adam, René; Radenne, Sylvie; Muscari, Fabrice; Conti, Filoména; Hardwigsen, Jean; Pageaux, Georges‐Philippe; Chazouillères, Olivier; Salamé, Ephrem; Hilleret, Marie‐Noëlle; Lebray, Pascal; Abergel, Armand; Debette-Gratien, Marilyne; Kluger, Michael D.; Mallat, Ariane; Azoulay, Daniel; Cherqui, Daniel

doi:10.1053/j.gastro.2012.05.052

Cited by 812 publications

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“…An AFP cutoff > 1000 ng/mL resulted in the potential exclusion of 4.7% of the patients from LT and a 20% reduction in HCC recurrence. These results are consistent with data obtained in a multicenter study 2 in which a prognostic model combining an AFP level > 1000 ng/mL and morphological aspects similarly predicted HCC recurrence in patients within the Milan criteria. Other authors have proposed using the AFP slope as a discriminating parameter, and this has resulted in the potential exclusion of 3.9% to 14.1% of patients.…”

Section: To the Editorssupporting

confidence: 91%

α-Fetoprotein and Hepatocellular Cancer Recurrence: A Paradigm of the Chaos Theory

Lai

Lerut

2014

Liver Transpl

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Section: To the Editorssupporting

confidence: 91%

α-Fetoprotein and Hepatocellular Cancer Recurrence: A Paradigm of the Chaos Theory

Lai

Lerut

2014

Liver Transpl

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“…In selection criteria for LT, the biological behavior of the tumor is replacing the size/number concept used by most of centers. [30][31][32] This study proved that even the biological behavior of the primary tumor has an impact on the outcome of the management of recurrent HCC. This should be a motive for further studies with larger cohorts of patients to evaluate the impact of pathological criteria of primary resected HCC and the characteristics of NTLP on the outcome of management of IHR, attempting for proper procedure/patient matching.…”

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confidence: 60%

Impact of pathological features of primary hepatocellular carcinoma on the outcomes of intrahepatic recurrence management: single center experience from Southern Taiwan

Ali

Wang

et al. 2016

HPB

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“…Despite the diversity of values reported in the literature, [2][3][4] we believe that very high levels of AFP (>1000 ng/mL) are restrictive because of the small number of patients who meet this criterion and the need for a better standard for organ allocation. …”

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confidence: 90%

Is there an ideal cutoff for α-fetoprotein as an exclusion criterion for liver transplantation?

et al. 2014

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TO THE EDITORS:Hameed et al.1 published a study on a-fetoprotein (AFP) as an exclusion criterion for liver transplantation (LT) in patients with hepatocellular carcinoma (HCC). We believe that they used a very high cutoff for AFP (>1000 ng/mL). Because of the retrospective nature of the study and the small sample with elevated AFP levels, we believe that it is difficult to take this value as definitive.We conducted a retrospective study of 768 patients undergoing LT between 1997 and 2010 (206 with a histological diagnosis of HCC). The leading cause of cirrhosis was also hepatitis C. Patients were followed for up to 173 months (mean 5 49.8 months). The survival of LT recipients at 1, 3, 5, and 14 years was 78.6%, 65.4%, 60.5%, and 38.7%, respectively. Survival was higher in the recurrence-free group versus patients with HCC recurrence (P < 0.001), and AFP levels correlated with tumor recurrence. At the 5-year posttransplant follow-up, the rate of HCC recurrence in patients with AFP levels < 50 ng/mL was 13.1%, whereas the rates were 29.4% for AFP levels of 50 to 200 ng/mL and 36.8% for AFP levels >200 ng/mL (P 5 0.002). A univariate analysis of risk factors for HCC recurrence revealed a hazard ratio (HR) of 3.85 [95% confidence interval (CI) 5 1.66-8.93, P 5 0.002] for AFP levels 200 ng/mL. Other risk factors for recurrence were the number of tumors (HR 5 1.37, 95% CI 5 1.20-1.56, P < 0.001), the degree of differentiation (HR 5 2.28, 95% CI 5 1.18-4.39, P 5 0.014), vascular invasion (HR 5 4.82, 95% CI 5 2.08-11.17, P < 0.001), and the presence of satellite nodules (HR 5 3.33, 95% CI 5 1.66-6.68, P 5 0.001). In a multivariate analysis, only AFP levels > 200 ng/mL remained a risk factor with an HR of 3.32 (95% CI 5 1.40-7.91, P 5 0.007).Despite the diversity of values reported in the literature, 2-4 we believe that very high levels of AFP (>1000 ng/mL) are restrictive because of the small number of patients who meet this criterion and the need for a better standard for organ allocation.

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Liver Transplantation for Hepatocellular Carcinoma: A Model Including α-Fetoprotein Improves the Performance of Milan Criteria

Cited by 812 publications

References 39 publications

α-Fetoprotein and Hepatocellular Cancer Recurrence: A Paradigm of the Chaos Theory

α-Fetoprotein and Hepatocellular Cancer Recurrence: A Paradigm of the Chaos Theory

Impact of pathological features of primary hepatocellular carcinoma on the outcomes of intrahepatic recurrence management: single center experience from Southern Taiwan

Is there an ideal cutoff for α-fetoprotein as an exclusion criterion for liver transplantation?

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