Number of hepatocellular carcinoma nodules in patients listed for liver transplantation within alpha‐fetoprotein score: a new prognostic risk factor. (15th March 2021)

• Record Type: Journal Article
• Authors: Mazzotta, Alessandro D.; Pascale, Alina; Cano, Luis; Rosmorduc, Olivier; Allard, Marc‐Antoine; Sa Cunha, Antonio; Adam, René; Cherqui, Daniel; Vibert, Eric; Golse, Nicolas
• Is Part Of: Transplant international. Volume 34:Number 5(2021)
• Page Start: 954
• Page End: 963
• Publication Date: 2021-03-15
• Subjects: hepatocellular carcinoma -- histopathology -- liver transplantation -- prognostic factor -- recurrence; Transplantation of organs, tissues, etc -- Periodicals; 617.95405
• DOI: 10.1111/tri.13858
• Languages: English
• ISSNs: 0934-0874

Abstract

Summary: In France, the listing for liver transplantation (LT) for hepatocellular carcinoma (HCC) requires an AFP score ≤2. This study evaluates whether the number of nodules assessed immediately before LT has a prognostic value among patients already listed within AFP score. Among 143 recipients transplanted with an AFP score ≤2 between 2013 and 2017 in our center, the number of nodules was considered at listing on the waiting list and at last imaging before LT. We compared the overall survival (OS) and disease‐free survival (DFS) post‐LT of patients with ≤3 and >3 nodules (current classification), and aimed to propose a new criteria to exclude patients on list at high risk of recurrence. The 3‐year OS of patients with ≤3 HCC vs. >3 HCC at listing was of 90.3% vs. 67.3%, respectively ( P = 0.04). At last imaging, eight listed patients presented ≥5 HCC nodules and had a significantly lower OS than <5 nodules patients (5‐year OS: 24.4% vs. 78.1%; P = 0.01). Although the current AFP score offers satisfactory outcomes, we highlight the poorer outcomes when ≥5 nodules persist or appear after listing. A modification of the AFP score is mandatory to consider exclusion of high‐risk patients already listed for LT program.