Abstract
Background and aim of the work
Hepatocellular carcinoma (HCC) is the sixth most common cancer in the world and the third most common cause of mortality in patients with cancer. HCC represents one of cirrhosis complications. The aim of this study was to assess pretransplantation α-fetoprotein (AFP) level as a predictor for HCC recurrence after living donor liver transplantation (LDLT).
Patients and methods
This is a cross-sectional retrospective study for patients with HCC who underwent LDLT and within Milan criteria. Preoperative assessment was performed to assess etiology, operability, and AFP. Locoregional therapy was performed preoperatively as a bridge therapy or for downstaging in patients beyond the Milan criteria. Postoperative abdominal ultrasound and AFP measurement have been performed for HCC recurrence surveillance, as routine investigations. If there is a suspicious lesion of HCC recurrence, triphasic computed tomographic scan is performed and biopsy may be performed.
Results
Data of 75 patients with HCC who underwent LDLT were analyzed retrospectively. Seventy-three patients were infected with hepatitis C virus; two of them were previously infected with hepatitis B virus, one patient with hepatitis B virus infection, and one patient had hepatitis C virus/hepatitis B virus coinfection. AFP may predict HCC recurrence after LDLT (area under the curve=0.806) at cutoff value of more than 66 ng/ml, with 60% sensitivity, 94.3% specificity, 42.9% positive predictive value, and 97.1% negative predictive value.
Conclusion
Preoperative serum AFP level may predict post-transplant HCC recurrence. It may be used in combination with other factors to create a prognostic model that may predict HCC recurrence after liver transplantation.
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References
Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005; 55:74–108.
Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v1. 1, cancer incidence and mortality worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2014.
Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma. Lancet 2012; 379:1245–1255.
El-Din Bessa SS, Elwan NM, Suliman GA, El-Shourbagy SH. Clinical significance of plasma osteopontin level in Egyptian patients with hepatitis C virus-related hepatocellular carcinoma. Arch Med Res 2010; 41:541–547.
Heimbach JK, Kulik LM, Finn RS, Sirlin CB, Abecassis MM, Roberts LR, et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology 2018; 67:358–380.
Hodeib H, ELshora O, Selim A, Sabry NM, El-Ashry HM. Serum midkine and osteopontin levels as diagnostic biomarkers of hepatocellular carcinoma. Electron Physician 2017; 9:3492–3498.
Schraiber Ldos S, de Mattos AA, Zanotelli ML, et al. Alpha-fetoprotein level predicts recurrence after transplantation in hepatocellular carcinoma. Medicine (Baltimore) 2016; 95:e2478.
Xu X, Ke QH, Shao ZX, Wu J, Chen J, Zhou L, Zheng SS. The value of serum alpha-fetoprotein in predicting tumor recurrence after liver transplantation for hepatocellular carcinoma. Dig Dis Sci 2009; 54:385–388.
Leung JY, Zhu AX, Gordon FD, Pratt DS, Mithoefer A, Garrigan K, et al. Liver transplantation outcomes for early-stage hepatocellular carcinoma: results of a multicenter study. Liver Transpl 2004; 11:1343–1354.
Zhou J, Fan J, Wu ZQ, Qiu SJ, Huang XW, Yu Y, et al. Liver transplantation for patients with hepatocellular carcinoma at the Liver Cancer Institute of Fudan University, China. Chin Med J 2005; 118:654–659.
Welker MW, Bechstein WO, Zeuzem S, Trojan J. Recurrent hepatocellular carcinoma after liver transplantation – an emerging clinical challenge. Transpl Int 2013; 26:109–118.
Hameed B, Mehta N, Sapisochin G, Roberts JP, Yao FY. Alpha-fetoprotein level >1000 ng/ml as an exclusion criterion for liver transplantation in patients with hepatocellular carcinoma meeting the Milan criteria. Liver Transpl 2014; 20:945–951.
Zou WL, Zang YJ, Chen XG, Shen ZY. Risk factors for fatal recurrence of hepatocellular carcinoma and their role in selecting candidates for liver transplantation. Hepatobiliary Pancreat Dis Int 2008; 7:145–151.
Figueras J, Ibañez L, Ramos E, Jaurrieta E, Ortiz-de-Urbina J, Pardo F, et al. Selection criteria for liver transplantation in early-stage hepatocellular carcinoma with cirrhosis: results of a multicenter study. Liver Transpl 2001; 7:877–883.
Ho MC, Wu YM, Hu RH, Ko WJ, Yang PM, Lai MY, et al. Liver transplantation for patients with hepatocellular carcinoma. Transplant Proc 2004; 36:2291–2292.
Pérez-Saborido B, de los Galanes SJ, Menéu-Díaz JC, Romero CJ, Elola-Olaso AM, Suárez YF, et al. Tumor recurrence after liver transplantation for hepatocellular carcinoma: recurrence pathway and prognostic factors. Transplant Proc 2007; 39:2304–2307.
Kashkoush S, El Moghazy W, Kawahara T, Gala-Lopez B, Toso C, Kneteman NM. Three-dimensional tumor volume and serum alpha fetoprotein are predictors of hepatocellular carcinoma recurrence after liver transplantation: refined selection criteria. Clin Transplant 2014; 28:728–736.
Sternby Eilard M, Holmberg E, Naredi P, Söderdahl G, Rizell M. Addition of alfa fetoprotein to traditional criteria for hepatocellular carcinoma improves selection accuracy in liver transplantation. Scand J Gastroenterol 2018; 53:976–983.
Kornberg A, Schernhammer M, Kornberg J, Friess H, Thrum K. Serological risk index based on alpha-fetoprotein and C-reactive protein to indicate futile liver transplantation among patients with advanced hepatocellular carcinoma. Dig Dis Sci 2018; 1:269–280 [Epub 2018 Sep 27].
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Galal, M., Bahaa, M., Ibrahim, W.A. et al. Pretransplantation α-fetoprotein level as a predictor of hepatocellular carcinoma recurrence after adult living donor liver transplantation within milan criteria in egyptian patients. Egypt J Intern Med 31, 203–207 (2019). https://doi.org/10.4103/ejim.ejim_106_18
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DOI: https://doi.org/10.4103/ejim.ejim_106_18