Alpha-fetoprotein and 18F-FDG positron emission tomography predict tumor recurrence better than Milan criteria in living donor liver transplantation

Hong, Geun; Suh, Kyung Suk; Suh, Sanggyun; Yoo, Tae Kyung; Kim, Hye Young; Park, Min Su; Choi, Young Rok; Paeng, Jin Chul; Yi, Nam Joon; Lee, Kwang Woong

doi:10.1016/j.jhep.2015.11.033

Cited by 112 publications

(98 citation statements)

References 28 publications

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“…These biologic markers include AFP, PIVKAII, and PET positivity (11,21,22). The combination of the serum AFP level and PET predicted outcomes better than using Milan criteria (13). Also, in our study also, overall SR and DFSR showed significant difference according to PET positivity and AFP level cut-off value of 200 ng/mL (P<0.001).…”

Section: Discussionsupporting

confidence: 56%

Living donor liver transplantation for hepatocellular carcinoma in Seoul National University

Hong¹,

Lee²,

Kim³

et al. 2016

Hepatobiliary Surg. Nutr.

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Background: Liver transplantation is an effective treatment modality for hepatocellular carcinoma (HCC).Due to deceased organ shortage, living donor liver transplantation (LDLT) accounts for the majority of liver transplants in Korea. The aim of this study is to evaluate the recent trend of LDLT for HCC, and to suggest guidelines and criteria for selecting the appropriate candidates for LDLT.Methods: Between January 2000 and December 2015, 532 patients underwent LDLT for HCC.Clinicopathologic data were analyzed as well as overall survival rate (SR) and disease-free survival rate (DFSR) according to the Milan criteria based on explant pathology, positron emission tomography (PET) positivity, and serum alpha-fetoprotein (AFP) level. Results:The 5-year overall SR and DFSR were 81.5% and 75.5% respectively. According to our previously reported combination of AFP and PET [Seoul National University Hospital (SNUH) criteria]; low risk group [AFP <200 ng/mL, PET (−)], intermediate risk group [AFP >200 ng/mL, PET (−) or AFP <200 ng/mL, PET (+)], and high risk group [AFP >200 ng/mL, PET (+)], the 5-year DFSR of low risk group was 86.1%, intermediate risk group was 79.0%, and high risk group was 18.5% (P<0.001). Within the Milan criteria, the 5-year DFSR of low risk group was 88.4%, intermediate risk group was 79.9%, and high risk group was 60.0% (P=0.016). Beyond the Milan criteria, the 5-year DFSR of low, intermediate, and high risk group was 80.3%, 77.7%, and 9.1%, respectively (P<0.001). Conclusions:In conclusion, our data and experience suggest that a continued paradigm shift from a conventional size based criteria to a biological marker based criteria is indicated when evaluating LDLT candidates with HCC.

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Section: Discussionsupporting

confidence: 56%

Living donor liver transplantation for hepatocellular carcinoma in Seoul National University

Hong¹,

Lee²,

Kim³

et al. 2016

Hepatobiliary Surg. Nutr.

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“…195 Retrospective AFP 400 ng/mL Total tumor diameter Histopathologic grade Lai et al [64] 2012 158 Retrospective AFP 400 ng/mL Total tumor diameter Duvoux et al [57] 2012 435 Prospective AFP 100 ng/mL, 1000 ng/mL Tumor size Number of tumors Kashkoush et al [76] 2014 115 Retrospective AFP 400 ng/mL Actual tumor volume Toso et al [75] 2015 233 Prospective AFP 400 ng/mL Total tumor volume Hong et al [77] 2015 123 Retrospective AFP 200 ng/mL F-FDG PET positivity Table 3 Suggestions for new selection criteria for liver transplantation that integrate α-fetoprotein AFP: Alpha-fetoprotein; F-FDG PET: F-fluorodeoxyglucose positron emission tomography.…”

Section: Resultsmentioning

confidence: 99%

“…Various teams have developed slightly different scores, still using an AFP cutoff value of 400 ng/mL but replacing TTD with total tumor volume [49,75] or actual tumor volume [76] . More recently, a Korean team suggested that a combination of AFP and FFDG PET data could be a very interesting selection tool [77] : A positive PET (cutoff at 1.10) and an AFP of > 200 ng/mL defined a group of patients with a high risk of recurrence and who should not be selected for LT. The main drawback of this study is the cost of FFDG PET, but the authors point out the usefulness of PET to predict tumor aggressiveness, rather than sheer size and number.…”

Section: Designing New Scores That Integrate Afp: the End Of The Mc?mentioning

confidence: 99%

Contribution of alpha-fetoprotein in liver transplantation for hepatocellular carcinoma

Charrière¹,

Maulat²,

Suc³

et al. 2016

WJH

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Alpha-fetoprotein (AFP) is the main tumor biomarker available for the management of hepatocellular carcinoma (HCC). Although it is neither a good screening test nor an accurate diagnostic tool for HCC, it seems to be a possible prognostic marker. However, its contribution in liver transplantation for HCC has not been fully determined, although its use to predict recurrence after liver transplantation has been underlined by international societies. In an era of organ shortages, it could also have a key role in the selection of patients eligible for liver transplantation. Yet unanswered questions remain. First, the cut-off value of serum AFP above which liver transplantation should not be performed is still a subject of debate. We show that a concentration of 1000 ng/mL could be an exclusion criterion, whereas values of < 15 ng/mL indicate patients with an excellent prognosis whatever the size and number of tumors. Monitoring the dynamics of AFP could also prove useful. However, evidence is lacking regarding the values that should be used. Today, the real input of AFP seems to be its integration into new criteria to select patients eligible for a liver transplantation. These recent tools have associated AFP values with morphological criteria, thus refining pre-existing criteria, such as Milan, University of California, San Francisco, or "up-to-seven". We provide a review of the different criteria submitted within the past years. Finally, AFP can be used to monitor recurrence after transplantation, although there is little evidence to support this claim. Future challenges will be to draft new international guidelines to implement the use of AFP as a selection tool, and to determine a clear cut-off value above which liver transplantation should not be performed.

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“…Therefore AFP is a well-established surrogate of tumor biology as it correlates with histologic grading and vascular invasion (14,(41)(42)(43). Not surprisingly, a large number of studies have highlighted the importance of increased AFP values for the recurrence risk after LT (3,23,(25)(26)(27)39,(41)(42)(43)(44)(45)(46)(47)(48). It is important to note that increased AFP values are not only a risk factor in patients beyond but also in patients within the Milan criteria.…”

Section: Futility Rule #4: (Persistently) Increased Afpmentioning

confidence: 99%

Hepatocellular carcinoma: when is liver transplantation oncologically futile?

Viveiros

Zoller

Finkenstedt

2017

Transl. Gastroenterol. Hepatol.

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Alpha-fetoprotein and 18F-FDG positron emission tomography predict tumor recurrence better than Milan criteria in living donor liver transplantation

Cited by 112 publications

References 28 publications

Living donor liver transplantation for hepatocellular carcinoma in Seoul National University

Living donor liver transplantation for hepatocellular carcinoma in Seoul National University

Contribution of alpha-fetoprotein in liver transplantation for hepatocellular carcinoma

Hepatocellular carcinoma: when is liver transplantation oncologically futile?

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