Role of Alpha-Fetoprotein in Selection of Patients with Hepatocellular Carcinoma Waiting for Liver Transplantation: Must we Reconsider it?

2011 ◽  
Vol 26 (3) ◽  
pp. 153-159 ◽  
Author(s):  
Quirino Lai ◽  
Alfonso W. Avolio ◽  
Tommaso M. Manzia ◽  
Salvatore Agnes ◽  
Giuseppe Tisone ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Multivariate Logistic Regression Analysis ◽  
Alpha Fetoprotein ◽  
Rank Test ◽  
Recurrence Prediction ◽  
Serum Alpha Fetoprotein ◽  
Selection Of Patients ◽  
Hcc Recurrence ◽  
Selection Of

Background Milan criteria (MC) represent the most commonly adopted criteria for the selection of patients with hepatocellular carcinoma (HCC) waiting for liver transplantation (LT). However, MC are exclusively based on morphological aspects. The aim of the present study was to evaluate pre-LT–detectable biological parameters, to compare them with morphological ones in terms of tumor recurrence prediction and patient survival. Methods A cohort of 153 consecutive adult patients who underwent LT for HCC on cirrhosis from January 1999 to March 2009 was retrospectively analyzed. Results HCC recurrence was observed in 12 patients (7.8%). At multivariate logistic regression analysis, serum alpha-fetoprotein (AFP) was the unique independent negative risk factor for the development of HCC recurrence (odds ratio 2.0, p=0.03). Adopting a cutoff value of 210 ng/mL, patients who presented serum AFP ≥210 ng/mL showed a 5-year survival rate of 23.3% versus 76.2% observed in patients with pre-LT serum AFP <210 ng/mL (log-rank test: <0.0001). Conclusions In our experience, AFP was the strongest predictor of HCC recurrence, stronger than tumor morphology. AFP could ameliorate the selection of LT candidates. Further studies to evaluate the combination of morphological and biological criteria are needed.

SERUM ALPHA-FETOPROTEIN MODIFICATION (DELTA-AFP) IS A HIGHLY SPECIFIC TOOL TO SUSPECT HCC RECURRENCE AFTER LIVER TRANSPLANTATION

2015 ◽  
Vol 47 ◽  
pp. e54
Author(s):  
F.R. Ponziani ◽  
S. Bhoori ◽  
M. Bongini ◽  
M. Flores ◽  
C. Muscarà ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Alpha Fetoprotein ◽  
Serum Alpha Fetoprotein ◽  
Hcc Recurrence

Extreme Elevation of Serum Alpha Fetoprotein in Decompensated Cirrhosis without Hcc: an Ominous Sign

2007 ◽  
Vol 22 (1) ◽  
pp. 19-23
Author(s):  
H. Senturk ◽  
R. Cumali
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Liver Cirrhosis ◽  
Liver Failure ◽  
Alpha Fetoprotein ◽  
Decompensated Cirrhosis ◽  
Serum Alpha Fetoprotein

Three cases of extreme elevation of serum alpha fetoprotein (>10,000 ng/mL) with decompensated cirrhosis without demonstrable hepatocellular carcinoma are reported. While 2 patients died of liver failure, 1 survived after liver transplantation. Extreme elevation of alpha fetoprotein not associated with hepatocellular carcinoma in liver cirrhosis heralds an ominous prognosis necessitating urgent liver transplantation.

scholarly journals “Liver Transplantation for Hepatocellular Carcinoma using Grafts from Uncontrolled Circulatory Death Donation Versus Brain Death Donation” 

2021 ◽  
Author(s):  
Anisa Nutu ◽  
Iago Justo ◽  
Alberto Marcacuzco ◽  
Óscar Caso ◽  
Alejandro Manrique ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Brain Death ◽  
Graft Survival ◽  
Patient Survival ◽  
Similar Patient ◽  
Serum Alpha Fetoprotein ◽  
Recipient Age ◽  
Hcc Recurrence ◽  
Circulatory Death

Abstract Controversy exists regarding whether the rate of hepatocellular carcinoma (HCC) recurrence after orthotopic liver transplantation (OLT) differs when using livers from donation after controlled circulatory death (DCD) versus livers from donation after brain death (DBD). The aim of this cohort study was to analyze rates of HCC recurrence, patient survival, and graft survival after OLT for HCC, comparing recipients of DBD livers (n=103) with recipients of uncontrolled DCD livers (uDCD; n=41). No significant differences in tumor size, tumor number, serum alpha-fetoprotein, proportion of patients within Milan criteria, or pre-OLT bridging therapies were identified between groups, although the waitlist period was significantly shorter in the uDCD group (p=0.04). HCC recurrence was similar between groups. Patient survival was similar between groups, but graft survival was lower in the uDCD group. Multivariate analysis identified recipient age (p=0.03), pre-OLT bridging therapy (p=0.02), and HCC recurrence (p=0.04) as independent risk factors for patient survival and pre-OLT transarterial chemoembolization (p=0.04) as the single risk factor for HCC recurrence. In conclusion, similar patient survival and lower graft survival were observed in the uDCD group. However, the use of uDCD livers appears to be justified due to shorter waitlist time and similar HCC recurrence in both groups.

scholarly journals Alpha-Fetoprotein, Protein Induced by Vitamin K Absence or Antagonist II and Glypican-3 for the Detection and Prediction of Hepatocellular Carcinoma in Patients with Cirrhosis of Viral Etiology

Cancers ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3218
Author(s):  
Gian Paolo Caviglia ◽  
Michela Ciruolo ◽  
Maria Lorena Abate ◽  
Patrizia Carucci ◽  
Emanuela Rolle ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Diagnostic Accuracy ◽  
Vitamin K ◽  
Area Under The Curve ◽  
Alpha Fetoprotein ◽  
Rank Test ◽  
Viral Etiology ◽  
Serum Samples ◽  
Serum Alpha Fetoprotein

International guidelines recommend the use of ultrasound as a surveillance tool for hepatocellular carcinoma (HCC) in patients with cirrhosis, while the role of serum biomarkers is still debated. We investigated serum alpha-fetoprotein (AFP), protein induced by vitamin K absence or antagonist II (PIVKA-II) and glypican-3 (GPC-3) diagnostic accuracy for HCC detection and prediction in patients with liver cirrhosis of viral etiology under surveillance. A total of 349 patients (200 cirrhosis and 149 HCC) were enrolled. The 200 patients with cirrhosis consisted of 114 patients still HCC-free after 36 months of follow-up and 86 patients that developed HCC after 13.8 (11.0–19.8) months. AFP, PIVKA-II and GPC-3 were measured in serum samples collected at tumor diagnosis in the 149 patients with HCC, and at the beginning of follow-up in the 200 patients with cirrhosis. The higher performance for HCC detection was observed for PIVKA-II (area under the curve (AUC) = 0.790), followed by AFP (AUC = 0.737) and GPC-3 (AUC = 0.637); the combination of AFP + PIVKA-II improved the diagnostic accuracy to AUC = 0.822. Serum PIVKA-II values, but not AFP and GPC-3, were significantly higher in the 86 cirrhotics that developed HCC compared with the 114 cirrhotics still HCC-free after 36 months of follow-up (p = 0.020). PIVKA-II ≥ 55 mAU/mL allowed to identify patients with cirrhosis at higher risk of HCC development (Log-rank test, p < 0.001; adjusted Hazard Ratio = 1.99, p = 0.001). In conclusion, the measurement of PIVKA-II in patients with cirrhosis may be useful to tailor personalized surveillance strategies.

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