Alpha-fetoprotein and modified response evaluation criteria in Solid Tumors progression after locoregional therapy as predictors of hepatocellular cancer recurrence and death after transplantation

Lai, Quirino; Avolio, Alfonso Wolfango; Graziadei, Ivo; Otto, Gerd; Rossi, Massimo; Tisone, Giuseppe; Goffette, Pierre; Vogel, Wolfgang; Pitton, Michael Bernhard; Lerut, Jan

doi:10.1002/lt.23706

Cited by 176 publications

(188 citation statements)

References 42 publications

Supporting

Mentioning

173

Contrasting

Unclassified

Order By: Relevance

“…In selection criteria for LT, the biological behavior of the tumor is replacing the size/number concept used by most of centers. [30][31][32] This study proved that even the biological behavior of the primary tumor has an impact on the outcome of the management of recurrent HCC. This should be a motive for further studies with larger cohorts of patients to evaluate the impact of pathological criteria of primary resected HCC and the characteristics of NTLP on the outcome of management of IHR, attempting for proper procedure/patient matching.…”

mentioning

confidence: 59%

Impact of pathological features of primary hepatocellular carcinoma on the outcomes of intrahepatic recurrence management: single center experience from Southern Taiwan

Ali

Wang

et al. 2016

HPB

View full text Add to dashboard Cite

show abstract

mentioning

confidence: 59%

Impact of pathological features of primary hepatocellular carcinoma on the outcomes of intrahepatic recurrence management: single center experience from Southern Taiwan

Ali

Wang

et al. 2016

HPB

View full text Add to dashboard Cite

show abstract

“…Although the numbers are small, this observation highlights the importance of change in AFP in the context of LRT while on the LT waiting list as Lai et al 5 have indicated from their recent multicenter study. We agree that there should be a "dynamic" approach to using AFP in the selection guidelines for LT that are readily adoptable in clinical practice.…”

Section: To the Editorsmentioning

confidence: 70%

Response to Letter to the Editors

Yao

Hameed²,

Mehta³

et al. 2014

Liver Transpl

View full text Add to dashboard Cite

TO THE EDITORS:We thank dos Santos Schraiber et al. 1 and Lai and Lerut 2 for their interest and comments regarding our study on applying alpha-fetoprotein (AFP) >1000 ng/ mL as an exclusion criterion for liver transplantation (LT) for hepatocellular carcinoma (HCC).3 dos Santos Schraiber et al.1 reported their experience with 206 patients receiving transplants for HCC and found that an AFP threshold of 200 ng/mL was predictive of HCC recurrence. They believed that the higher AFP >1000 ng/mL used in our study was restrictive and that our results were based on a small number of patients. We recognize the small number of patients with AFP >1000 ng/mL to be a limitation, but our results are entirely consistent with those reported from a recent large study published by the Liver Transplantation French Study Group in the subgroup of patients meeting Milan criteria. 4 The key question of our study is how many patients would have to be excluded from LT at a specific AFP threshold to prevent 1 HCC recurrence. We found that applying an AFP level >1000 ng/mL as the cutoff would have resulted in the exclusion of approximately 5% of patients for LT and a 20% reduction in the rate of HCC recurrence. The 5-year survival without HCC recurrence was 80% after excluding those with pre-LT AFP >1000 ng/mL. Applying a lower AFP threshold (>300 ng/mL to >500 ng/mL) would have resulted in a slightly greater reduction in the HCC recurrence rate but at the expense of excluding more patients from LT who did not have tumor recurrence and would have benefited from LT. We also found AFP >1000 ng/mL to have the highest specificity in predicting vascular invasion as well as post-LT HCC recurrence compared with a lower AFP.We agree with Lai and Lerut's 2 comments about the complexity of using AFP as a variable in exclusion of candidates for LT. We should point out that, among the 211 patients in our study cohort, 12 patients had an initial AFP >1000 ng/mL at LT listing who showed a decrease in AFP to <1000 ng/mL by the time of LT as a result of local regional therapy (LRT), and only 1 of these 12 patients suffered from HCC recurrence after LT. Although the numbers are small, this observation highlights the importance of change in AFP in the context of LRT while on the LT waiting list as Lai et al. 5 have indicated from their recent multicenter study. We agree that there should be a "dynamic" approach to using AFP in the selection guidelines for LT that are readily adoptable in clinical practice. At our center, we have implemented a policy in which those with an initial AFP >1000 ng/ mL are required to show a decrease in AFP to <500 ng/ mL with LRT before they can undergo LT.

show abstract

“…Such slope was able to strongly predict post-LT recurrence, and microvascular invasion [24] . Finally, the European multicenter experience (EURHECALT study) performed on 306 patients meeting and 116 exceeding MC showed that mRECIST progression during waiting time and AFP slope > 15 ng/mL per month were the sole predictors of tumor recurrence and post-LT death [25] . All the reported studies are reassumed in Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…Vibert et al [23] adopted the value obtained from the difference between the lowest and highest measured divided by the lapse of time passed between the two measurements; our group (Lai et al [25] ) adopted the measures at the moment of waiting-list inscription and at moment of LT. Both methods insufficiently show the real behavior of AFP changes overtime because they are not able to completely capture the AFP oscillations during the time.…”

Section: Resultsmentioning

confidence: 99%

Selection tool alpha-fetoprotein for patients waiting for liver transplantation: How to easily manage a fractal algorithm

Lai

Sandri

Lerut

2015

WJH

Self Cite

View full text Add to dashboard Cite

Alpha-fetoprotein (AFP) behavior in patients with hepatocellular carcinoma (HCC) waiting for liver transplant (LT) represents a perfect biological example of a fractal model in which its progressive modification and possible future prediction of its values are very hard to capture. As a consequence, AFP represents a useful but poorly manageable tool to increase the ability to better select HCC patients waiting for LT. Trying to find a "filrouge" in the recent literature, no definitive answers can be done to several open questions: (1) the best AFP value to adopt; (2) the best cut-off measurement; and (3) the best way to comfortably capture the effective, time-related, fluctuations of this biological marker. More, structured and prospective, studies using serial determination of AFP values within and without the context of locoregional therapies are needed in order to find the "ideal" (static and dynamic) cut-off values allowing to respond to all the still open questions in this field of transplant oncology. Core tip: Alpha-fetoprotein (AFP) behavior in patients with hepatocellular carcinoma waiting for liver transplant (LT) represents a perfect example of a fractal model. Consequently, AFP represents a useful but poorly manageable selection tool for patients waiting for LT. Looking at the recent literature, we can assume that: (1) last AFP value seem to be the best values to adopt; (2) different cut-offs may be adopted in the two different scenarios of Milan Criteria (MC) IN and MC OUT status; (3) AFP cut-off of 1000 ng/mL represent EDITORIAL Submit a

show abstract

Alpha-fetoprotein and modified response evaluation criteria in Solid Tumors progression after locoregional therapy as predictors of hepatocellular cancer recurrence and death after transplantation

Cited by 176 publications

References 42 publications

Impact of pathological features of primary hepatocellular carcinoma on the outcomes of intrahepatic recurrence management: single center experience from Southern Taiwan

Impact of pathological features of primary hepatocellular carcinoma on the outcomes of intrahepatic recurrence management: single center experience from Southern Taiwan

Response to Letter to the Editors

Selection tool alpha-fetoprotein for patients waiting for liver transplantation: How to easily manage a fractal algorithm

Contact Info

Product

Resources

About