Pre-Transplant Alpha-Fetoprotein > 25.5 and Its Dynamic on Waitlist Are Predictors of HCC Recurrence after Liver Transplantation for Patients Meeting Milan Criteria
Background and Aim: Hepatocellular carcinoma (HCC) recurrence rates after liver transplantation (LT) range between 8 and 20%. Alpha-fetoprotein (AFP) levels at transplant can predict HCC recurrence, however a defined cut-off value is needed to better stratify patients. The aim of this study was to e...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-11-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/13/23/5976 |
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| author | Bianca Magro Domenico Pinelli Massimo De Giorgio Maria Grazia Lucà Arianna Ghirardi Alessandra Carrobio Giuseppe Baronio Luca Del Prete Franck Nounamo Andrea Gianatti Michele Colledan Stefano Fagiuoli |
| author_facet | Bianca Magro Domenico Pinelli Massimo De Giorgio Maria Grazia Lucà Arianna Ghirardi Alessandra Carrobio Giuseppe Baronio Luca Del Prete Franck Nounamo Andrea Gianatti Michele Colledan Stefano Fagiuoli |
| author_sort | Bianca Magro |
| collection | DOAJ |
| description | Background and Aim: Hepatocellular carcinoma (HCC) recurrence rates after liver transplantation (LT) range between 8 and 20%. Alpha-fetoprotein (AFP) levels at transplant can predict HCC recurrence, however a defined cut-off value is needed to better stratify patients. The aim of this study was to evaluate the rate of HCC recurrence at our centre and to identify predictors, focusing on AFP. Methods: We retrospectively analysed 236 consecutive patients that were waitlisted for HCC who all met the Milan criteria from January 2001 to December 2017 at our liver transplant centre. A total of twenty-nine patients dropped out while they were waitlisted, and 207 patients were included in the final analysis. All survival analyses included the competing-risk model. Results: The mean age was 56.8 ± 6.8 years. A total of 14% were female (<i>n</i> = 29/207). The median MELD (model for end-stage liver disease) at LT was 12 (9–16). The median time on the waitlist was 92 (41–170) days. The HCC recurrence rate was 16.4% (<i>n</i> = 34/208). The mean time to recurrence was 3.3 ± 2.8 years. The median AFP levels at transplant were higher in patients with HCC recurrence (<i>p</i> < 0.001). At multivariate analysis, the AFP value at transplant that was greater than 25.5 ng/mL (AUC 0.69) was a strong predictor of HCC recurrence after LT [sHR 3.3 (1.6–6.81); <i>p</i> = 0.001]. The HCC cumulative incidence function (CIF) of recurrence at 10 years from LT was significantly higher in patients with AFP > 25.5 ng/mL [34.3% vs. 11.5% (<i>p</i> = 0.001)]. Moreover, an increase in AFP > 20.8%, was significantly associated with HCC recurrence (<i>p</i> = 0.034). Conclusions: In conclusion, in our retrospective study, the AFP level at transplant > 25.5 ng/mL and its increase greater than 20.8% on the waitlist were strong predictors of HCC recurrence after LT in a cohort of patients that were waitlisted within the Milan criteria. However further studies are needed to validate these data. |
| first_indexed | 2024-03-10T04:56:25Z |
| format | Article |
| id | doaj.art-9d4131fa2c0e4ea2862fd29651c2f8df |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T04:56:25Z |
| publishDate | 2021-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-9d4131fa2c0e4ea2862fd29651c2f8df2023-11-23T02:12:29ZengMDPI AGCancers2072-66942021-11-011323597610.3390/cancers13235976Pre-Transplant Alpha-Fetoprotein > 25.5 and Its Dynamic on Waitlist Are Predictors of HCC Recurrence after Liver Transplantation for Patients Meeting Milan CriteriaBianca Magro0Domenico Pinelli1Massimo De Giorgio2Maria Grazia Lucà3Arianna Ghirardi4Alessandra Carrobio5Giuseppe Baronio6Luca Del Prete7Franck Nounamo8Andrea Gianatti9Michele Colledan10Stefano Fagiuoli11Gastroenterology, Hepatology and Liver Transplantation, Department of Medicine-Papa Giovanni, XXIII Hospital, 24122 Bergamo, ItalyUnit of Hepato-Biliary Surgery and Liver Transplantation, ASST Papa Giovanni XXIII, 24122 Bergamo, ItalyGastroenterology, Hepatology and Liver Transplantation, Department of Medicine-Papa Giovanni, XXIII Hospital, 24122 Bergamo, ItalyGastroenterology, Hepatology and Liver Transplantation, Department of Medicine-Papa Giovanni, XXIII Hospital, 24122 Bergamo, ItalyFROM Research Foundation, Papa Giovanni XXIII Hospital, 24122 Bergamo, ItalyFROM Research Foundation, Papa Giovanni XXIII Hospital, 24122 Bergamo, ItalyUnit of Hepato-Biliary Surgery and Liver Transplantation, ASST Papa Giovanni XXIII, 24122 Bergamo, ItalyUnit of Hepato-Biliary Surgery and Liver Transplantation, ASST Papa Giovanni XXIII, 24122 Bergamo, ItalyUnit of Hepato-Biliary Surgery and Liver Transplantation, ASST Papa Giovanni XXIII, 24122 Bergamo, ItalyPathology Unit, ASST Papa Giovanni XXIII, 24122 Bergamo, ItalyUnit of Hepato-Biliary Surgery and Liver Transplantation, ASST Papa Giovanni XXIII, 24122 Bergamo, ItalyGastroenterology, Hepatology and Liver Transplantation, Department of Medicine-Papa Giovanni, XXIII Hospital, 24122 Bergamo, ItalyBackground and Aim: Hepatocellular carcinoma (HCC) recurrence rates after liver transplantation (LT) range between 8 and 20%. Alpha-fetoprotein (AFP) levels at transplant can predict HCC recurrence, however a defined cut-off value is needed to better stratify patients. The aim of this study was to evaluate the rate of HCC recurrence at our centre and to identify predictors, focusing on AFP. Methods: We retrospectively analysed 236 consecutive patients that were waitlisted for HCC who all met the Milan criteria from January 2001 to December 2017 at our liver transplant centre. A total of twenty-nine patients dropped out while they were waitlisted, and 207 patients were included in the final analysis. All survival analyses included the competing-risk model. Results: The mean age was 56.8 ± 6.8 years. A total of 14% were female (<i>n</i> = 29/207). The median MELD (model for end-stage liver disease) at LT was 12 (9–16). The median time on the waitlist was 92 (41–170) days. The HCC recurrence rate was 16.4% (<i>n</i> = 34/208). The mean time to recurrence was 3.3 ± 2.8 years. The median AFP levels at transplant were higher in patients with HCC recurrence (<i>p</i> < 0.001). At multivariate analysis, the AFP value at transplant that was greater than 25.5 ng/mL (AUC 0.69) was a strong predictor of HCC recurrence after LT [sHR 3.3 (1.6–6.81); <i>p</i> = 0.001]. The HCC cumulative incidence function (CIF) of recurrence at 10 years from LT was significantly higher in patients with AFP > 25.5 ng/mL [34.3% vs. 11.5% (<i>p</i> = 0.001)]. Moreover, an increase in AFP > 20.8%, was significantly associated with HCC recurrence (<i>p</i> = 0.034). Conclusions: In conclusion, in our retrospective study, the AFP level at transplant > 25.5 ng/mL and its increase greater than 20.8% on the waitlist were strong predictors of HCC recurrence after LT in a cohort of patients that were waitlisted within the Milan criteria. However further studies are needed to validate these data.https://www.mdpi.com/2072-6694/13/23/5976HCCalpha fetoproteinliver transplantationcirrhosisrecurrence |
| spellingShingle | Bianca Magro Domenico Pinelli Massimo De Giorgio Maria Grazia Lucà Arianna Ghirardi Alessandra Carrobio Giuseppe Baronio Luca Del Prete Franck Nounamo Andrea Gianatti Michele Colledan Stefano Fagiuoli Pre-Transplant Alpha-Fetoprotein > 25.5 and Its Dynamic on Waitlist Are Predictors of HCC Recurrence after Liver Transplantation for Patients Meeting Milan Criteria Cancers HCC alpha fetoprotein liver transplantation cirrhosis recurrence |
| title | Pre-Transplant Alpha-Fetoprotein > 25.5 and Its Dynamic on Waitlist Are Predictors of HCC Recurrence after Liver Transplantation for Patients Meeting Milan Criteria |
| title_full | Pre-Transplant Alpha-Fetoprotein > 25.5 and Its Dynamic on Waitlist Are Predictors of HCC Recurrence after Liver Transplantation for Patients Meeting Milan Criteria |
| title_fullStr | Pre-Transplant Alpha-Fetoprotein > 25.5 and Its Dynamic on Waitlist Are Predictors of HCC Recurrence after Liver Transplantation for Patients Meeting Milan Criteria |
| title_full_unstemmed | Pre-Transplant Alpha-Fetoprotein > 25.5 and Its Dynamic on Waitlist Are Predictors of HCC Recurrence after Liver Transplantation for Patients Meeting Milan Criteria |
| title_short | Pre-Transplant Alpha-Fetoprotein > 25.5 and Its Dynamic on Waitlist Are Predictors of HCC Recurrence after Liver Transplantation for Patients Meeting Milan Criteria |
| title_sort | pre transplant alpha fetoprotein 25 5 and its dynamic on waitlist are predictors of hcc recurrence after liver transplantation for patients meeting milan criteria |
| topic | HCC alpha fetoprotein liver transplantation cirrhosis recurrence |
| url | https://www.mdpi.com/2072-6694/13/23/5976 |
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