Format

Send to

Choose Destination
Liver Int. 2016 Nov;36(11):1657-1667. doi: 10.1111/liv.13159. Epub 2016 Jun 15.

Liver transplantation for hepatocellular carcinoma: evaluation of the alpha-fetoprotein model in a multicenter cohort from Latin America.

Author information

1
Hospital Universitario Austral, Pilar, Argentina. fpinerof@cas.austral.edu.ar.
2
Hospital Universitario Austral, Pilar, Argentina.
3
Hospital de Clinicas, State University of Campinas, Campinas, Brazil.
4
Hospital Pablo Tobón Uribe, Medellin, Colombia.
5
Universidad de Antioquía, Medellin, Colombia.
6
Hospital Italiano from Buenos Aires, Buenos Aires, Argentina.
7
Fundación Cardioinfantil, Instituto de Cardiología, Bogotá, Colombia.
8
Hospital Alemán, Buenos Aires, Argentina.
9
Sanatorio Allende from Córdoba, Córdoba, Argentina.
10
Hospital Militar-Clínicas, Montevideo, Uruguay.
11
Clinica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile.
12
Hospital del Salvador, Universidad de Chile, Santiago, Chile.
13
Hospital Universitario de Monterrey, Monterrey, Mexico.
14
Hospital Guillermo Almenara, Lima, Perú.
15
Hospital Universidad Católica de Chile, Santiago, Chile.
16
Hospital Clínico Universidad de Chile, Santiago, Chile.
17
Henri Mondor Hospital, University of Paris-Est, Creteil, France.

Abstract

BACKGROUND & AIMS:

The French alpha-fetoprotein (AFP) model has recently shown superior results compared to Milan criteria (MC) for prediction of hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT) in European populations. The aim of this study was to explore the predictive capacity of the AFP model for HCC recurrence in a Latin-American cohort.

METHODS:

Three hundred twenty-seven patients with HCC were included from a total of 2018 patients transplanted at 15 centres. Serum AFP and imaging data were both recorded at listing. Predictability was assessed by the Net Reclassification Improvement (NRI) method.

RESULTS:

Overall, 82 and 79% of the patients were within MC and the AFP model respectively. NRI showed a superior predictability of the AFP model against MC. Patients with an AFP score >2 points had higher risk of recurrence at 5 years Hazard Ratio (HR) of 3.15 (P = 0.0001) and lower patient survival (HR = 1.51; P = 0.03). Among patients exceeding MC, a score ≤2 points identified a subgroup of patients with lower recurrence (5% vs 42%; P = 0.013) and higher survival rates (84% vs 45%; P = 0.038). In cases treated with bridging procedures, following restaging, a score >2 points identified a higher recurrence (HR 2.2, P = 0.12) and lower survival rate (HR 2.25, P = 0.03). A comparative analysis between HBV and non-HBV patients showed that the AFP model performed better in non-HBV patients.

CONCLUSIONS:

The AFP model could be useful in Latin-American countries to better select patients for LT in subgroups presenting with extended criteria. However, particular attention should be focused on patients with HBV.

KEYWORDS:

alpha-fetoprotein; candidate selection; liver cancer; prediction

PMID:
27169841
DOI:
10.1111/liv.13159
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center