Delta‐slope of alpha‐fetoprotein improves the ability to select liver transplant patients with hepatocellular cancer. Issue 12 (December 2015)

• Record Type: Journal Article
• Authors: Lai, Quirino; Inostroza, Milton; Rico Juri, Juan M.; Goffette, Pierre; Lerut, Jan
• Is Part Of: HPB. Volume 17:Issue 12(2015:Dec.)
• Page Start: 1085
• Page End: 1095
• Publication Date: 2015-12
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1111/hpb.12486
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: Objective: The aim of the present study was to investigate the role of different alpha‐foetoprotein (AFP) determinations in order to propose a new model aimed at predicting intention‐to‐treat (ITT) death and post‐ liver transplantation (LT) recurrence in a cohort of patients with hepatocellular cancer (HCC) enlisted for LT. Background: Recent studies have increasingly focused on the role of AFP as a useful tool for patient selection in the setting of LT for HCC. However, no definitive AFP model has been definitively validated. Methods: A retrospective analysis was performed on 124 consecutive patients enlisted for LT in a UCL Brussels LT centre during the period January 2004 to March 2012. The median follow‐up was 3.3 years (ranges: 1.7–6.3). Results: The area under the receiver‐operating characteristic (AUROC) analysis showed the ability of the AFP delta‐slope as a useful prognosticator of tumour‐related drop‐out and post‐LT recurrence. In multivariate analyses, the delta‐slope was an independent predictor of ITT death [hazard ratio (HR) = 1.014, P < 0.017] and post‐LT tumour recurrence (HR = 1.020, P = 0.027). The 5‐year ITT survival and disease‐free survival rates were 66.0% versus 36.7% and 92.3% versus 53.8%, for patients meeting and exceeding the delta‐slope cut‐off value of 15 ng/ml/month, respectively. Conclusions: Integration of the AFP delta‐slope with conventional criteria may further improve patient selection and post‐LT outcomes; prospective studies are needed to validate the present proposed model.