title: Preoperative alpha-fetoprotein slope is predictive of hepatocellular carcinoma recurrence after liver transplantation.
abstract: BACKGROUND
  Liver transplantation (LT) offers a possible cure for patients with hepatocellular carcinoma (HCC) and cirrhosis. However, tumour progression while on the waiting list and tumour recurrence after LT are common. The prognostic significance of various pre- and postoperative variables were investigated in regard to tumour recurrence, with an emphasis on the slope of preoperative serum alpha-fetoprotein (AFP) levels. patients and
  
  
  METHODS
  Data from 48 patients who had HCC diagnosed preoperatively and underwent LT at the McGill University Health Centre (Montreal, Quebec) were reviewed retrospectively, and possible risk factors for tumour recurrence were examined.
  
  
  RESULTS
  Univariate analysis revealed a positive correlation between the preoperative AFP slope and vascular invasion (P = 0.045), total tumour diameter at explant (P = 0.040), Cancer of the Liver Italian Program score (P = 0.017) and recurrence-free survival (P = 0.028). Of the preoperative variables examined, only the preoperative AFP slope was identified as an independent predictor of tumour recurrence by multivariate analysis. Receiver operating characteristic analysis showed that the best discriminant cut-off value, calculated as the value of the maximized likelihood ratio, was preoperative AFP slope greater than 50 microg/L per month. At this cut-off, sensitivity was 36%, and specificity was 97%. Patients with a preoperative AFP slope greater than 50 microg/L per month had a much worse one-year recurrence-free survival rate than those with a preoperative AFP slope 50 microg/L per month or less (40% versus 90%, P < 0.001).
  
  
  CONCLUSIONS
  These results suggest that the preoperative AFP slope is an important predictor of HCC recurrence after LT and should be examined in future studies of patients receiving LT for HCC.
authors.affiliation: Liver Transplant Program, Royal Victoria Hospital, McGill University Health Center, Montreal, Canada.
authors.forename: Kathy
authors.initials: K
authors.lastname: Han
authors.forename: George N
authors.initials: GN
authors.lastname: Tzimas
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Barkun
authors.forename: Peter
authors.initials: P
authors.lastname: Metrakos
authors.forename: Jean L
authors.initials: JL
authors.lastname: Tchervenkov
authors.forename: Nir
authors.initials: N
authors.lastname: Hilzenrat
authors.forename: Phil
authors.initials: P
authors.lastname: Wong
authors.forename: Marc
authors.initials: M
authors.lastname: Deschênes
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000032:analysis; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D012189:Retrospective Studies; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D015415:Biomarkers; D000509:alpha-Fetoproteins