J Korean Med Sci.  2016 Jul;31(7):1049-1054. 10.3346/jkms.2016.31.7.1049.

Peri-Transplant Change in AFP Level: a Useful Predictor of Hepatocellular Carcinoma Recurrence Following Liver Transplantation

• Yoo T
• Lee KW
• Yi NJ
• Choi YR
• Kim H
• Suh SW
• Jeong JH
• Lee JM
• Suh KS

• KMID: 2373722
• DOI: http://doi.org/10.3346/jkms.2016.31.7.1049

Abstract

Pretransplant alpha-fetoprotein (AFP) is a useful tumor marker predicting recurrence of hepatocellular carcinoma (HCC). Little is known, however, about the relationship between changes in AFP concentration and prognosis. This study investigated the clinical significance of change in peri-transplant AFP level as a predictor of HCC recurrence. Data from 125 HCC patients with elevated pretransplant AFP level who underwent liver transplantation (LT) between February 2000 and December 2010 were retrospectively reviewed. Patients with AFP normalization within 1 month after LT were classified into the rapid normalization group (n = 97), with all other patients classified into the non-rapid normalization group (n = 28). Tumor recurrence was observed in 17 of the 97 patients (17.5%) with rapid normalization; of these, 11 patients had high AFP levels and six had normal levels at recurrence. In contrast, tumor recurrence was observed in 24 of the 28 patients (85.7%) without rapid normalization, with all 24 having high AFP levels at recurrence. Multivariate analysis showed that non-rapid normalization (harzard ratio [HR], 4.41, P < 0.001), sex (HR, 3.26, P = 0.03), tumor size (HR, 1.15, P = 0.001), and microvascular invasion (HR, 2.65, P = 0.005) were independent risk factors for recurrence. In conclusion, rapid normalization of post-LT AFP level at 1 month is a useful clinical marker for HCC recurrence. Therefore, an adjuvant strategy and/or intensive screening are needed for patients who do not show rapid normalization.

Keyword

Alpha-Fetoprotein; Tumor Marker; Liver Cancer; Hepatocellular Carcinoma; Liver Transplantation

MeSH Terms

Adult
Aged
Aged, 80 and over
Biomarkers, Tumor/analysis
Carcinoma, Hepatocellular/blood/mortality/*pathology/therapy
Female
Humans
Kaplan-Meier Estimate
Liver Neoplasms/blood/mortality/*pathology/therapy
*Liver Transplantation
Male
Middle Aged
Multivariate Analysis
Neoplasm Recurrence, Local
Proportional Hazards Models
Retrospective Studies
Risk Factors
Severity of Illness Index
alpha-Fetoproteins/analysis
Biomarkers, Tumor
alpha-Fetoproteins

Figure

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  Fig. 1 Patient distribution according to peri-transplant AFP concentrations in HCC patients with elevated pre-transplant AFP level. (n = 125)

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  Fig. 2 Recurrence-free survival according to change in post-transplant AFP level in HCC patients with elevated pre-transplant AFP levels. (A) RFS rates are higher in patients with rapid normalization of AFP within 1 month (Group R) than in patients with slow normalization of AFP within 1-3 months (Group S) or in patients with persistently elevated AFP level (Group P). (B) RFS rates were higher in Group R than in patients with non-rapid normalization of AFP level (Group R).

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  Fig. 3 Recurrence-free survival according to post-transplant AFP levels in HCC patients within (A) or beyond (B) the Milan criteria. (Group R; patients with rapid normalization of AFP level within 1 month after LT; Group NR, patients with non-rapid normalization of AFP)

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  Fig. 4 Recurrence-free survival according to the combination of degree of pre-transplant AFP level and peri-transplant AFP changes. RFS rates were highest in patients with rapid normalization of post-transplant AFP and moderately elevated pre-LT AFP, although outcomes were also good in patients with rapid normalization of post-transplant AFP and highly elevated pre-LT AFP. Patients without rapid normalization of post-LT AFP showed poor outcomes, regardless of the degree of pre-LT AFP. (Group R, patients with rapid normalization of AFP level within 1 month; Group NR, patients with non-rapid normalization of AFP)

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