BACKGROUND: Milan criteria (MC) represent the most commonly adopted criteria for the selection of patients with hepatocellular carcinoma (HCC) waiting for liver transplantation (LT). However, MC are exclusively based on morphological aspects. The aim of the present study was to evaluate pre-LT-detectable biological parameters, to compare them with morphological ones in terms of tumor recurrence prediction and patient survival. METHODS: A cohort of 153 consecutive adult patients who underwent LT for HCC on cirrhosis from January 1999 to March 2009 was retrospectively analyzed. RESULTS: HCC recurrence was observed in 12 patients (7.8%). At multivariate logistic regression analysis, serum alpha-fetoprotein (AFP) was the unique independent negative risk factor for the development of HCC recurrence (odds ratio 2.0, p=0.03). Adopting a cutoff value of 210 ng/mL, patients who presented serum AFP =210 ng/mL showed a 5-year survival rate of 23.3% versus 76.2% observed in patients with pre-LT serum AFP <210 ng/mL (log-rank test: <0.0001). CONCLUSIONS: In our experience, AFP was the strongest predictor of HCC recurrence, stronger than tumor morphology. AFP could ameliorate the selection of LT candidates. Further studies to evaluate the combination of morphological and biological criteria are needed.
BACKGROUND: Milan criteria (MC) represent the most commonly adopted criteria for the selection of patients with hepatocellular carcinoma (HCC) waiting for liver transplantation (LT). However, MC are exclusively based on morphological aspects. The aim of the present study was to evaluate pre-LT-detectable biological parameters, to compare them with morphological ones in terms of tumor recurrence prediction and patient survival. METHODS: A cohort of 153 consecutive adult patients who underwent LT for HCC on cirrhosis from January 1999 to March 2009 was retrospectively analyzed. RESULTS: HCC recurrence was observed in 12 patients (7.8%). At multivariate logistic regression analysis, serum alpha-fetoprotein (AFP) was the unique independent negative risk factor for the development of HCC recurrence (odds ratio 2.0, p=0.03). Adopting a cutoff value of 210 ng/mL, patients who presented serum AFP =210 ng/mL showed a 5-year survival rate of 23.3% versus 76.2% observed in patients with pre-LT serum AFP <210 ng/mL (log-rank test: <0.0001). CONCLUSIONS: In our experience, AFP was the strongest predictor of HCC recurrence, stronger than tumor morphology. AFP could ameliorate the selection of LT candidates. Further studies to evaluate the combination of morphological and biological criteria are needed.
Authors: Arno Kornberg; Martina Schernhammer; Jennifer Kornberg; Helmut Friess; Katharina Thrum Journal: Dig Dis Sci Date: 2018-09-27 Impact factor: 3.199
Authors: Christine C Hsu; Abhishek Goyal; Alina Iuga; Saravanan Krishnamoorthy; Valerie Lee; Elizabeth C Verna; Shuang Wang; Fei-Na Chen; Rosa Rodriguez; Jean Emond; Paul Berk; Jay Lefkowitch; Lorna Dove; Robert S Brown; Abby B Siegel Journal: Clin Transl Gastroenterol Date: 2015-02-05 Impact factor: 4.488
Authors: Zhendong Gao; Gang Du; Yuguang Pang; Zhihao Fu; Chongzhong Liu; Yi Liu; Binghai Zhou; Du Kong; Binyao Shi; Zhengcheng Jiang; Bin Jin Journal: Medicine (Baltimore) Date: 2017-08 Impact factor: 1.889
Authors: Quirino Lai; Fabio Melandro; Rafael S Pinheiro; Andrea Donfrancesco; Bashir A Fadel; Giovanni B Levi Sandri; Massimo Rossi; Pasquale B Berloco; Fabrizio M Frattaroli Journal: Int J Hepatol Date: 2012-06-27