Change in Alpha-fetoprotein after Loco-Regional Therapy as Predictor of Recurrence after Liver Transplantation for Hepatocellular Carcinoma: A Multicenter European Study

Abstract

Background: Loco-regional therapies (LRT) are routinely adopted for the treatment of hepatocellular carcinoma (HCC) in patients waiting for liver transplantation (LT). However, their role has not been completely investigated. Moreover, pre-LT recurrence predictors usable in clinical practice may be extrapolated by these therapeutic approaches. Methods: The present study investigated the predictive parameters for the risk of post-LT recurrence in 361 patients with HCC treated with LRTs and then transplanted in 5 European centres (Brussels, Innsbruck, Rome Cattolica, Rome Tor Vergata and Rome Sapienza). Results: Thirty-nine recurrences (10.8%) were reported. At linear regression, microvascular invasion, Milan criteria (MC) exceeded at pathology and alpha-fetoprotein (AFP) increased after the last LRT were significant. Considering only pre-LT available variables, AFP increased after the last LRT was the unique risk factor for HCC recurrence after LT (p-value 0.001; Odds Ratio 3.52).Figure: [Distribution according to the modification of AFP]Figure: [Odds ratios of recurrence determinants]MC-in patients at radiology with decreased AFP showed the best disease-free survivals (5-year: 77%): MC-in patients with increased AFP or MC-out patients with decreased AFP showed intermediate results, while patients exceeding MC and with an increase of AFP values presented the worse results (5-year: 31.3%; p-value < 0.0001).Figure: [Disease-free survival curves]Conclusions: Decreased AFP appears relevant in documenting good response to LRT in patients waiting for LT. AFP reduction minimizes the risk of recurrence even in patients exceeding MC. AFP reduction should be used in combination with radiological MC with the intent to ameliorate the patient selection.