Liver transplantation for hepatocellular carcinoma: evaluation of the alpha‐fetoprotein model in a multicenter cohort from Latin America. (15th June 2016)

• Record Type: Journal Article
• Authors: Piñero, Federico; Tisi Baña, Matías; de Ataide, Elaine Cristina; Hoyos Duque, Sergio; Marciano, Sebastian; Varón, Adriana; Anders, Margarita; Zerega, Alina; Menéndez, Josemaría; Zapata, Rodrigo; Muñoz, Linda; Padilla Machaca, Martín; Soza, Alejandro; McCormack, Lucas; Poniachik, Jaime; Podestá, Luis G.; Gadano, Adrian; Boin, Ilka S. F. Fatima; Duvoux, Christophe; Silva, Marcelo
• Other Names: Andriani Oscar investigator.; Gil Octavio investigator.; Barrabino Martín investigator.; Maraschio Martín investigator.; Boteon Yuri Longatto investigator.; Diaz Juan Carlos investigator.; Montenegro Cristian investigator.; Ibarra Jose investigator.; Jarufe Nicolas investigator.; Restrepo Juan Carlos investigator.; Hoyos Isabel Arenas investigator.; Santos Luisa investigator.; Garzón Martín investigator.; Rondon Carlos investigator.; Chaman Jose investigator.; Gerona Solange investigator.
• Is Part Of: Liver international. Volume 36:Number 11(2016)
• Page Start: 1657
• Page End: 1667
• Publication Date: 2016-06-15
• Subjects: alpha‐fetoprotein -- candidate selection -- liver cancer -- prediction; Liver -- Periodicals; Liver -- Diseases -- Periodicals; 616.362
• DOI: 10.1111/liv.13159
• Languages: English
• ISSNs: 1478-3223

Abstract

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. Abstract : See Editorial on Page1580