Alpha-fetoprotein and tumour size are associated with microvascular invasion in explanted livers of patients undergoing transplantation with hepatocellular carcinoma

McHugh, Patrick P.; Gilbert, John E.; Vera, Santiago; Koch, Alvaro; Ranjan, Dinesh; Gedaly, Roberto

doi:10.1111/j.1477-2574.2009.00128.x

Cited by 120 publications

(91 citation statements)

References 26 publications

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“…However, it seems difficult to use the cut-off value of 400 ng/mL to directly exclude patients from a waiting list, because this value has been mostly studied as part of algorithms that include tumor volume, tumor size, the MC, and/or the UCSFcriteria. Moreover, many other cutoff values have been suggested, such as 100 ng/mL [47,57,67] and 200 ng/ mL [10,68] . The level of evidence to define an optimal value is very weak and thus calls for further studies.…”

Section: Defining a Cut-off Value For Afpmentioning

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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Section: Defining a Cut-off Value For Afpmentioning

confidence: 99%

Contribution of alpha-fetoprotein in liver transplantation for hepatocellular carcinoma

Charrière¹,

Maulat²,

Suc³

et al. 2016

WJH

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“…Preoperative AFP may be the best available surrogate marker for micro-vascular invasion and the biological aggressiveness of the tumour. Several studies have identified a high pre-operative AFP as a risk factor for recurrence and reduced survival [18,[20][21][22] . We have shown AFP predicted reduced disease free survival, independent of both tumour size and micro-vascular invasion.…”

Section: Discussionmentioning

confidence: 99%

Liver transplantation for hepatocellular carcinoma in Ireland: Pre-operative alpha-fetoprotein predicts tumour recurrence in a 14-year single-centre national experience

O’Connor

Burke

Hegarty

et al. 2016

WJT

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AIM:To examine the results of orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) in Ireland over a 14-year period. METHODS:Cases of HCC receiving OLT between January 1995 and September 2009 in the Irish Liver Transplant Unit were reviewed from a prospectively maintained database. Outcome measures included overall and recurrence free survival, alpha-fetoprotein (AFP) and tumour pathological features. RESULTS: Core tip:We have shown good survival from a medium volume transplant centre in a small cohort of patients exceeding Milan criteria. We show an association between a pre-operative alpha-fetoprotein (AFP) > 100 and hepatocellular carcinoma (HCC) recurrence, independent of tumour size. Our study supports other single centre experience on survival after transplant for HCC with low AFP and indicates that AFP needs to be interrogated in large, multi-centre studies to see if it can be included in transplant listing criteria to augment the current radiology based dimensional criteria.

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“…A United States study including 101 patients showed that AFP > 100 ng/mL (OR = 5.0, P = 0.006) and tumor size (OR = 4.1, P = 0.013) were correlated with microvascular invasion and post-LT recurrence [12] . Another Polish study including 121 HCC patients confirmed the validity of 100 ng/mL as cut-off value in predicting the risk of post-LT recurrence in patients meeting San Francisco criteria or up-to-seven criteria [13] .…”

Section: Recurrence: Role Of Static Valuesmentioning

confidence: 99%

“…The San Francisco transplant center underlined the recent implementation in their inclusion policy for LT to include patients with AFP levels > 1000 ng/mL only if LRT enabled to decrease this level beneath 500 ng/mL [21] . A Canadian study including 48 patients showed by 1901 July 28, 2015|Volume 7|Issue 15| WJH|www.wjgnet.com McHugh et al [12] 2010 101 United States 100 Grąt et al [13] 2014 121 Poland 100 Abdel-Wahab et al [14] 2013 170 (LDLT) Egypt 200 Lai et al [15] 2011 153 Italy 210 Harimoto et al [16] 2013 167 (LDLT) Japan 300 Merani et al [6] 2011 6817 United States 400 Toso et al [7] 2009 6478 United States 400 Zheng et al [8] 2008…”

Section: From Static To Dynamicmentioning

confidence: 99%

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

Lai

Sandri

Lerut

2015

WJH

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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

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Alpha-fetoprotein and tumour size are associated with microvascular invasion in explanted livers of patients undergoing transplantation with hepatocellular carcinoma

Abstract: MVI greatly increases the risk of recurrence and death after LT for HCC, and is strongly associated with tumour size and AFP > 100.

Cited by 120 publications

References 26 publications

Contribution of alpha-fetoprotein in liver transplantation for hepatocellular carcinoma

Contribution of alpha-fetoprotein in liver transplantation for hepatocellular carcinoma

Liver transplantation for hepatocellular carcinoma in Ireland: Pre-operative alpha-fetoprotein predicts tumour recurrence in a 14-year single-centre national experience

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

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